ABSTRACT
BACKGROUND: Ensuring appropriate outpatient follow-up is a mainstay of Emergency Medicine to avoid poor patient outcomes. During the COVID-19 pandemic, many post-ED discharge visits were rapidly transitioned from inperson to telehealth. Our study investigates the associations between ED recidivism or subsequent hospitalization after either telehealth or in-person visits follow-up visits. We hypothesize that telehealth visits are less successful than in-person visits at preventing either outcome. METHODS: This retrospective study used electronic health record data from an urban academic health system. All adult patients were included if they presented to either of two in-system EDs between 1/1/20 - 10/31/21 with a chief complaint of chest pain, syncope, abdominal pain, or altered mental status. If patients had multiple ED visits, only their first was included. The post-ED follow-up window was restricted to two weeks. We used multivariate logistic regressions, which controlled for patient age, sex, race, ethnicity, primary language, insurance type, and social vulnerability index, to estimate the association between the type of post-ED follow-up and two outcomes within 30 days after the follow-up appointment: 1) returning to the ED or 2) hospitalization. RESULTS: Of 23,856 ED visits that met criteria, 10,180 (42%) had follow-up telehealth visits, 3,925 (16%) had in-person follow-up, and 9,760 (40%) had no follow-up. A total of 2,119 (9%) patients returned to the ED after their follow-up: 12% of whom had telehealth visits, 7% had in-person visits, and 6% had no follow-up visit. 684 (3%) of patients were admitted: 6% of those with telehealth visits, 2% with in-person visits, and 0.2% with no follow-up visit. Compared to having no visit, telehealth visits were associated with an adjusted OR (aOR) of returning to the ED of 2.7 (95% CI, 2.4 -3.1), and in-person visits were associated with an aOR of 1.8 (95% CI, 1.5 -2.1). Compared to those with an in-person visit, telehealth follow-up was associated with an aOR of 1.5 (95% CI, 1.3 -1.8) of returning to the ED. Compared to having no visit, telehealth visits were associated with an aOR of 27.8 (95% CI, 17.4 -44.4), and in-person visits were associated with an aOR of 12.1 (95% CI, 7.2 -20.1) of hospitalization. Compared to those with an in-person visit, telehealth was associated with an aOR of 2.3 (95% CI, 1.8 -2.9) of hospitalization. All aORs were significant with p < 0.001. CONCLUSIONS: Telehealth follow-up visits were associated with higher odds of returning to the ED and hospitalization compared to in-person visits;though some of this association is likely due to patients who are sicker choosing telemedicine over in-person, this finding also suggests in-person follow-up may be more effective than telehealth at decreasing repeat ED visits and hospitalizations. Further analysis that adjusts for patient comorbidities and illness severity will help us to better understand the impact of post-ED followup on ED recidivism and hospitalization.