Michael S Yoo, Lawrence S Block, Lue-Yen Tucker, Julia Wei, Kawai Cheung, Mary E Reed
{"title":"2019冠状病毒病疫情时期住院后远程医疗随访和30天再入院：大型综合医疗系统的多阶段分析","authors":"Michael S Yoo, Lawrence S Block, Lue-Yen Tucker, Julia Wei, Kawai Cheung, Mary E Reed","doi":"10.1002/jhm.70109","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Timely postdischarge visits reduce readmissions, but the impact of telemedicine follow-up remains unclear. The coronavirus disease 2019 (COVID-19) pandemic rapidly expanded telemedicine, offering a unique opportunity to assess its impact on outcomes.</p><p><strong>Objectives: </strong>Evaluate the association between telemedicine versus in-person follow-up and 30-day outcomes before, during, and after the COVID-19 pandemic.</p><p><strong>Methods: </strong>Retrospective cohort study of adults discharged from the Medicine Service across 21 hospitals (2017-2023). Telemedicine (video/telephone) versus in-person visits within 7 days of discharge were compared. The primary outcome was 30-day nonelective readmission. Secondary outcomes included 30-day all-cause readmission, emergency department (ED) visits, and mortality. Competing risk and Cox regression models were used, with inverse probability of treatment weighting to address differences.</p><p><strong>Results: </strong>Among 137,765 patients (mean age 67.5 years, 49.1% female), 59.2% received telemedicine follow-up. Pre-pandemic, 28.2% had telemedicine visits, associated with higher 30-day nonelective readmission risk (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI]: 1.19-1.28, p < .01) and mortality (aHR: 1.87, 95% CI: 1.71-2.05, p < .01). During COVID-19, telemedicine was associated with lower nonelective readmission risk (aHR: 0.92, 95% CI: 0.88-0.97, p < .01), fewer ED visits (aHR: 0.88, 95% CI: 0.84-0.92, p < .01), and no difference in mortality (aHR: 1.10, 95% CI: 0.98-1.24, p = .11). Post-COVID-19, readmission and ED visit risks were similar, though mortality was higher in the telemedicine group (aHR: 1.33, 95% CI: 1.20-1.49, p < .01).</p><p><strong>Conclusions: </strong>Telemedicine follow-up was associated with favorable outcomes during the pandemic, supporting its use as an alternative to in-person care. Pre- and postpandemic differences likely reflect patient selection. A hybrid follow-up model may optimize access and outcomes in postdischarge care.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Posthospitalization telemedicine follow-up and 30-day readmission across the COVID-19 era: A multiphase analysis in a large integrated healthcare system.\",\"authors\":\"Michael S Yoo, Lawrence S Block, Lue-Yen Tucker, Julia Wei, Kawai Cheung, Mary E Reed\",\"doi\":\"10.1002/jhm.70109\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Timely postdischarge visits reduce readmissions, but the impact of telemedicine follow-up remains unclear. The coronavirus disease 2019 (COVID-19) pandemic rapidly expanded telemedicine, offering a unique opportunity to assess its impact on outcomes.</p><p><strong>Objectives: </strong>Evaluate the association between telemedicine versus in-person follow-up and 30-day outcomes before, during, and after the COVID-19 pandemic.</p><p><strong>Methods: </strong>Retrospective cohort study of adults discharged from the Medicine Service across 21 hospitals (2017-2023). Telemedicine (video/telephone) versus in-person visits within 7 days of discharge were compared. The primary outcome was 30-day nonelective readmission. Secondary outcomes included 30-day all-cause readmission, emergency department (ED) visits, and mortality. Competing risk and Cox regression models were used, with inverse probability of treatment weighting to address differences.</p><p><strong>Results: </strong>Among 137,765 patients (mean age 67.5 years, 49.1% female), 59.2% received telemedicine follow-up. Pre-pandemic, 28.2% had telemedicine visits, associated with higher 30-day nonelective readmission risk (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI]: 1.19-1.28, p < .01) and mortality (aHR: 1.87, 95% CI: 1.71-2.05, p < .01). During COVID-19, telemedicine was associated with lower nonelective readmission risk (aHR: 0.92, 95% CI: 0.88-0.97, p < .01), fewer ED visits (aHR: 0.88, 95% CI: 0.84-0.92, p < .01), and no difference in mortality (aHR: 1.10, 95% CI: 0.98-1.24, p = .11). Post-COVID-19, readmission and ED visit risks were similar, though mortality was higher in the telemedicine group (aHR: 1.33, 95% CI: 1.20-1.49, p < .01).</p><p><strong>Conclusions: </strong>Telemedicine follow-up was associated with favorable outcomes during the pandemic, supporting its use as an alternative to in-person care. Pre- and postpandemic differences likely reflect patient selection. A hybrid follow-up model may optimize access and outcomes in postdischarge care.</p>\",\"PeriodicalId\":94084,\"journal\":{\"name\":\"Journal of hospital medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-07-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of hospital medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1002/jhm.70109\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of hospital medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/jhm.70109","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Posthospitalization telemedicine follow-up and 30-day readmission across the COVID-19 era: A multiphase analysis in a large integrated healthcare system.
Background: Timely postdischarge visits reduce readmissions, but the impact of telemedicine follow-up remains unclear. The coronavirus disease 2019 (COVID-19) pandemic rapidly expanded telemedicine, offering a unique opportunity to assess its impact on outcomes.
Objectives: Evaluate the association between telemedicine versus in-person follow-up and 30-day outcomes before, during, and after the COVID-19 pandemic.
Methods: Retrospective cohort study of adults discharged from the Medicine Service across 21 hospitals (2017-2023). Telemedicine (video/telephone) versus in-person visits within 7 days of discharge were compared. The primary outcome was 30-day nonelective readmission. Secondary outcomes included 30-day all-cause readmission, emergency department (ED) visits, and mortality. Competing risk and Cox regression models were used, with inverse probability of treatment weighting to address differences.
Results: Among 137,765 patients (mean age 67.5 years, 49.1% female), 59.2% received telemedicine follow-up. Pre-pandemic, 28.2% had telemedicine visits, associated with higher 30-day nonelective readmission risk (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI]: 1.19-1.28, p < .01) and mortality (aHR: 1.87, 95% CI: 1.71-2.05, p < .01). During COVID-19, telemedicine was associated with lower nonelective readmission risk (aHR: 0.92, 95% CI: 0.88-0.97, p < .01), fewer ED visits (aHR: 0.88, 95% CI: 0.84-0.92, p < .01), and no difference in mortality (aHR: 1.10, 95% CI: 0.98-1.24, p = .11). Post-COVID-19, readmission and ED visit risks were similar, though mortality was higher in the telemedicine group (aHR: 1.33, 95% CI: 1.20-1.49, p < .01).
Conclusions: Telemedicine follow-up was associated with favorable outcomes during the pandemic, supporting its use as an alternative to in-person care. Pre- and postpandemic differences likely reflect patient selection. A hybrid follow-up model may optimize access and outcomes in postdischarge care.
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