ED Return Visit, Hospitalization More Likely After Telehealth Follow-up

Patients who participated in follow-up visits through telehealth after an emergency department (ED) visit were more likely to return to the ED and be admitted to the hospital than those who had a follow-up visit in person, according to a new study.

For the study, published in JAMA Network Open this week, researchers examined differences in the rates of return ED visits and hospitalization between patients who participated in in-person follow-ups after an initial ED visit and those who had a virtual follow-up visit.

They conducted a retrospective cohort study that included adult patients who visited one of two EDs at an integrated urban academic health system from April 1, 2020, to Sept. 30, 2021. These patients were discharged from the ED and participated in a follow-up appointment with a primary care physician within 14 days of their visit.

Researchers gathered data for 12,848 adult patients with 16,987 initial ED visits, of which 11,818 (70 percent) had an in-person follow-up and 5,169 (30 percent) had a telehealth follow-up.

Overall, 17 percent of the initial ED visits resulted in a return visit to the ED, and 4 percent led to the patient being hospitalized.

Researchers found that 16 percent of patients who received a post-ED follow-up in person returned to the ED, and 4 percent were admitted to the hospital within 30 days. Among patients who participated in a virtual follow-up visit post-ED discharge, 18 percent returned to the ED, and 5 percent were hospitalized within 30 days.

Adjusted analyses further revealed that telehealth follow-up visits were associated with 28.3 more ED return visits per 1,000 encounters and 10.6 more hospitalizations per 1,000 encounters than in-person follow-ups.

Researchers concluded that "the association of telehealth with increased health care utilization warrants further study to evaluate its appropriateness as modality for post-ED follow-up."

But the study results do not mean that telehealth is not an appropriate modality for other types of care, researchers stated in a press release.

"It’s just that in the current context, telehealth may not be appropriate for all ED follow-up care,” said Vivek Shah, MD, resident physician in the department of emergency medicine at Harbor-UCLA Medical Center. "Other groups have shown the benefits of telehealth in specific scenarios with clear care plans, such as chronic obstructive pulmonary disease, heart failure, or diabetes management. But the scenario of an ED follow-up is different in that patients may be seen for a myriad of acute conditions, rather than chronic conditions that their primary care physician knows well or has been managing for many years."

And telehealth visits for acute conditions have been linked to a higher likelihood of follow-up care as compared with in-person appointments.  

Previous research also shows telehealth use is not generally linked to increased healthcare utilization. A study from last year shows that telehealth visits for primary care services did not lead to any significant increases in in-person follow-up visits, hospitalizations, or prescription orders.

In addition, research has shown that telehealth can help boost access to follow-up care. For example, a study published at the beginning of the year found that Black patients saw a higher increase in post-discharge follow-up appointments than White patients in the early months of the COVID-19 pandemic. This indicates that virtual care may have increased access to follow-up visits for this patient population.