ArticleThe western journal of emergency medicine2025
Telehealth Emergency Department Transition-of-care Program: A Value-based Innovation.
Article in The western journal of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionOur Emergency Department (ED) and Population Health Services Organization developed a telehealth ED-transition of care program (TOC) for patients insured through value-based contracts. This study's goal was to determine the association of our ED-TOC on ED revisits. We hypothesized that the ED-TOC would decrease ED revisits.
methodsThis was a retrospective cohort study conducted between August 1, 2021 and July 31, 2023 at two EDs where an ED-TOC is available. Included were ED visits among discharged Medicare beneficiaries that occurred one year before and after the launch of the ED-TOC program. ED visits involving Medicaid beneficiaries served as the control. A difference-in-differences (DID) strategy was used to compare Medicare and Medicaid visits. The primary outcome measure was the association of the program with 14- and 30- day ED revisit rates. Secondary outcomes were the association of the ED-TOC with post-discharge PCP visits and hospitalizations and estimated cost-savings associated with the program.
resultsOur sample size was 23,696 ED encounters (13,553 treatment group and 10,143 control group). At 14-days after ED discharge, Medicare beneficiaries were associated with a 1.77% decrease in the rate of ED revisits in the year after the ED-TOC launch relative to the control (p=0.03) or a 15.8% reduction relative to baseline (11.2% to 9.4%). At 14-days after ED discharge, PCP visits were associated with a 1.51% increase in the year after program launch relative to the control (p=0.03) or a 10.3% increase relative to baseline (14.6% to 16.1%). No difference was associated with Medicare beneficiaries' ED revisits or hospitalizations at 30-days. PCP visits were associated with a significant increase at 30-days (p=0.005).
conclusionAn ED-TOC is associated with a reduction in Medicare ED revisits during days 8-14 after an index ED visit but not during days 1-7 days or at 30-days. Cost savings over a 24-week period are conservatively calculated to be $215,779.
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