Nicholas M Mohr1,2,3, J Priyanka Vakkalanka1,3, Karisa K Harland1, Amanda Bell4, Brian Skow4, Dan M Shane5, Marcia M Ward5. 1. 1 Department of Emergency Medicine, University of Iowa College of Medicine , Iowa City, Iowa. 2. 2 Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine , Iowa City, Iowa. 3. 3 Department of Epidemiology, University of Iowa College of Public Health , Iowa City, Iowa. 4. 4 Avera eCARE , Sioux Falls, South Dakota. 5. 5 Department of Health Management and Policy, University of Iowa College of Public Health , Iowa City, Iowa.
Abstract
BACKGROUND: Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes. OBJECTIVES: This study was conducted to describe the effect of telemedicine on management and clinical outcomes for trauma patients in North Dakota. METHODS: Cohort study of adult (age ≥18 years) trauma patients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014. Records were linked to a telemedicine network's call records, indicating whether telemedicine was available and/or used at the institution at the time of the care. Multivariable generalized estimating equations were developed to identify associations between telemedicine consultation and availability and outcomes such as transfer, timeliness of care, trauma imaging, and mortality. RESULTS: Of the 7,500 North Dakota trauma patients seen in CAH, telemedicine was consulted for 11% of patients in telemedicine-capable EDs and 4% of total trauma patients. Telemedicine utilization was independently associated with decreased initial ED length of stay (LOS) (30 min, 95% confidence interval [CI] 14-45 min) for transferred patients. Telemedicine availability was associated with an increase in the probability of interhospital transfer (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4). Telemedicine availability was associated with increased total ED LOS (15 min, 95% CI 10-21 min), and computed tomography scans (aOR 1.6, 95% CI 1.3-1.9). CONCLUSIONS: ED-based telemedicine consultation is requested for the most severely injured rural trauma patients. Telemedicine consultation was associated with more rapid interhospital transfer, and telemedicine availability is associated with increased radiography use and transfer. Future work should evaluate how telemedicine could target patients likely to benefit from telemedicine consultation.
BACKGROUND: Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes. OBJECTIVES: This study was conducted to describe the effect of telemedicine on management and clinical outcomes for traumapatients in North Dakota. METHODS: Cohort study of adult (age ≥18 years) traumapatients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014. Records were linked to a telemedicine network's call records, indicating whether telemedicine was available and/or used at the institution at the time of the care. Multivariable generalized estimating equations were developed to identify associations between telemedicine consultation and availability and outcomes such as transfer, timeliness of care, trauma imaging, and mortality. RESULTS: Of the 7,500 North Dakota traumapatients seen in CAH, telemedicine was consulted for 11% of patients in telemedicine-capable EDs and 4% of total traumapatients. Telemedicine utilization was independently associated with decreased initial ED length of stay (LOS) (30 min, 95% confidence interval [CI] 14-45 min) for transferred patients. Telemedicine availability was associated with an increase in the probability of interhospital transfer (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4). Telemedicine availability was associated with increased total ED LOS (15 min, 95% CI 10-21 min), and computed tomography scans (aOR 1.6, 95% CI 1.3-1.9). CONCLUSIONS: ED-based telemedicine consultation is requested for the most severely injured rural traumapatients. Telemedicine consultation was associated with more rapid interhospital transfer, and telemedicine availability is associated with increased radiography use and transfer. Future work should evaluate how telemedicine could target patients likely to benefit from telemedicine consultation.
Entities:
Keywords:
emergency medicine/teletrauma; emergency service; hospital; length of stay; rural health; telemedicine; wounds and injuries
Authors: Aspen C Miller; Marcia M Ward; Fred Ullrich; Kimberly A S Merchant; Morgan B Swanson; Nicholas M Mohr Journal: Telemed J E Health Date: 2020-02-28 Impact factor: 3.536
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Authors: Sarah Heppner; Nicholas M Mohr; Knute D Carter; Fred Ullrich; Kimberly A S Merchant; Marcia M Ward Journal: PLoS One Date: 2021-01-12 Impact factor: 3.240
Authors: Nicholas M Mohr; Karisa K Harland; Uche E Okoro; Brian M Fuller; Kalyn Campbell; Morgan B Swanson; Stephen Q Simpson; Edith A Parker; Luke J Mack; Amanda Bell; Katie DeJong; Brett Faine; Anne Zepeski; Keith Mueller; Elizabeth Chrischilles; Christopher R Carpenter; Michael P Jones; Marcia M Ward Journal: J Comp Eff Res Date: 2021-01-20 Impact factor: 1.744
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