Telemedicine Use and Outcomes Following Discharge from the Emergency Department, 2020-2022

Study objective To describe the use of telemedicine for outpatient follow-up care after discharge from the emergency department (ED) in a large cohort of patients with commercial insurance or Medicare Advantage and determine whether telemedicine follow-up was associated with greater return hospitalizations compared with in-person care. Methods Using administrative claims data, we conducted a retrospective cohort study of adults discharged from the ED with congestive heart failure, diabetes, chronic obstructive pulmonary disease, or asthma, from 2020 to 2022. The primary outcome was modality of the first outpatient visit within 14 days, either in person or via telemedicine. We used multivariable logistic regression to examine patient characteristics associated with use of telemedicine compared with in-person follow-up. We also used time-to-event methods to estimate the risk of return hospitalization for patients who obtained telemedicine versus in-person follow-up. Results Among 147,561 patients discharged from the ED (mean age 63.9 years; 56.5% women), we found that 4,107 (2.8%) obtained telemedicine follow-up visits and 34,882 (23.6%) obtained in-person follow-up. An additional 7,487 (5.1%) patients were hospitalized prior to obtaining any follow-up. Use of telemedicine varied across conditions and was associated with younger age, female sex, more comorbidities, and ED visit complexity. Telemedicine was not associated with greater risk of return hospitalization compared with in-persnon follow-up. Conclusion ED patients used telemedicine for outpatient follow-up visits at low rates, with comparable rates of return hospitalization to those who obtained in-person follow-up. Future studies may examine focused interventions to deploy telemedicine to expand access to follow-up care for selected patients.