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Standard nurse phone triage versus tele–emergency care pilot on Veteran use of in-person acute care: An instrumental variable analysis

dc.contributor.authorLi, Kathleen Y.
dc.contributor.authorKim, Paul S.
dc.contributor.authorThariath, Joshua
dc.contributor.authorWong, Edwin S.
dc.contributor.authorBarkham, Jonathan
dc.contributor.authorKocher, Keith E.
dc.date.accessioned2023-05-01T19:11:56Z
dc.date.available2024-05-01 15:11:55en
dc.date.available2023-05-01T19:11:56Z
dc.date.issued2023-04
dc.identifier.citationLi, Kathleen Y.; Kim, Paul S.; Thariath, Joshua; Wong, Edwin S.; Barkham, Jonathan; Kocher, Keith E. (2023). "Standard nurse phone triage versus tele–emergency care pilot on Veteran use of in-person acute care: An instrumental variable analysis." Academic Emergency Medicine (4): 310-320.
dc.identifier.issn1069-6563
dc.identifier.issn1553-2712
dc.identifier.urihttps://hdl.handle.net/2027.42/176303
dc.description.abstractObjectivesUse of acute care telemedicine is growing, but data on quality, utilization, and cost are limited. We evaluated a Veterans Affairs (VA) tele–emergency care (tele-EC) pilot aimed at reducing reliance on out-of-network (OON) emergency department (ED) care, a growing portion of VA spending. With this service, an emergency physician virtually evaluated selected Veterans calling a nurse triage line.MethodsCalls to the triage line occurring January–December 2021 and advised to seek care acutely within 24 h were included. We described tele-EC user characteristics, common triage complaints, and patterns in referral to and management by tele-EC. The primary outcome was acute care visits (ED, urgent care, and hospitalizations at VA and OON sites) within 7 days of the index call. Secondary outcomes included mortality, OON acute care spending, and the effect of tele-EC visit modality (phone vs. video). We used both standard regression and instrumental variable (IV) analysis, using the tele-EC physician schedule as the instrument.ResultsOf 7845 eligible calls, 15.5% had a tele-EC visit, with case resolution documented in 57%. Compared to standard nurse triage, tele-EC users were less likely to be Black, had more prior ED visits, and were triaged as higher acuity. Calls concerning dizziness/syncope, blood in stool, and chest pain were most likely to have a tele-EC visit. Tele-EC was associated with fewer ED visits than standard nurse triage in both regression (average marginal effect [AME] −16.8%, 95% confidence interval [CI] −19.2 to −14.4) and IV analyses (AME −17.5%, 95% CI −25.1 to −9.8), lower hospitalization rate (AME −3.1%, 95% CI −6.2 to −0.0), and lower OON spending (AME –$248, 95% CI −$458 to −$38).ConclusionsAmong Veterans initially advised to seek care within 24 h, use of tele-EC compared to standard phone triage led to decreased ED visits, hospitalizations, and OON spending within 7 days.
dc.publisherWiley Periodicals, Inc.
dc.publisherDepartment of Veterans Affairs (US)
dc.titleStandard nurse phone triage versus tele–emergency care pilot on Veteran use of in-person acute care: An instrumental variable analysis
dc.typeArticle
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelMedicine (General)
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/176303/1/acem14681_am.pdf
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/176303/2/acem14681.pdf
dc.identifier.doi10.1111/acem.14681
dc.identifier.sourceAcademic Emergency Medicine
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dc.working.doiNOen
dc.owningcollnameInterdisciplinary and Peer-Reviewed


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