This project's main purpose was to analyze data using the revised Tele-Emergency Performance Assessment Reporting Tool gathered from Evidence-Based Tele-Emergency Network Grant Program (EB TNGP) grantees on all of their cases using telehealth in the emergency department (tele-ED) and a matched sample of non-tele-ED records to conduct comparative effectiveness analysis to help establish the evidence base for tele-ED. The data collection period covered November 2015 through December 2017. During this period, the EB TNGP grantees provided services to 4,324 tele-ED encounters. Non-tele-ED control cases for selected intervention conditions (acute myocardial infarction, chest pain, severe sepsis/shock, and stroke) were used along with the tele-ED cases for manuscripts on the comparative effectiveness analysis of each of these conditions. In addition, manuscripts were published focuses on comparing and contrasting general tele-ED service with specialized tele-ED services for pediatrics and for behavioral health. Additional manuscripts were written describing the rate and effect of averted transfers and time to treatment. The findings from this EB TNGP effort have contributing substantially to the evidence base for tele-ED.

Publications

• Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six Networks
  Journal Article
  Rural Telehealth Research Center
  Date: 08/2020
  In a cohort of 4,324 tele-ED cases across 26 months in 65 hospitals in 6 tele-ED networks, 20% were averted transfers, and 43% of those were then routinely discharged rather than being transferred. Averted transfers saved on average $2,673 in avoidable transport costs per patient, with 63.6% of these cost savings accruing to public insurance.
• Emergency Department Telemedicine Consults Are Associated With Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients
  Journal Article
  Rural Telehealth Research Center
  Date: 02/2020
  Acute myocardial infarction (AMI) is a common, deadly emergency requiring rapid diagnosis and treatment. In this rural cohort, emergency department-based telemedicine was associated with improved timeliness of electrocardiogram and fibrinolysis. This study adds to evidence that telemedicine can improve timeliness of AMI care in rural hospitals.
• Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort
  Journal Article
  Rural Telehealth Research Center
  Date: 11/2019
  This was a study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication. The effect of tele-ED varied by network, suggesting network characteristics may influence the realized tele-ED benefit for stroke care.
• HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-Site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks
  Journal Article
  Rural Telehealth Research Center
  Date: 01/2021
  The Health Resources and Services Administration funded six grantees to provide telehealth services in rural emergency departments (tele-ED) and gather data for the telehealth evidence base. This paper examines trends across multiple tele-ED networks and heterogeneity in processes and outcomes.
• Identifying Measures and Data Elements for the HRSA Evidence-Based Tele-Emergency Network Grant Program
  Policy Brief
  Rural Telehealth Research Center
  Date: 03/2020
  This brief details multi-project work to identify measures and develop data elements appropriate to emergency department-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration Evidence-Based Tele-Emergency Network Grant Program.
• Pediatric Tele-Emergency Care: A Study of Two Delivery Models
  Journal Article
  Rural Telehealth Research Center
  Date: 04/2019
  This study describes two tele-emergency programs that provide care to pediatric populations. Qualitative descriptions of the two tele-emergency department (ED) models and key characteristics of the patient populations served by tele-ED are presented. The study informs others about evaluative measures and how tele-ED works in practice.
• Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments
  Journal Article
  Rural Telehealth Research Center
  Date: 01/2020
  Sepsis is a life-threatening emergency, and timely "bundled" care improves survival. In this rural cohort, telemedicine in the emergency department (tele-ED) improved sepsis bundle adherence, including timely fluid resuscitation and antibiotic administration. Tele-ED may be a scalable intervention to improve sepsis emergency care in rural EDs.
• Tele-Emergency Behavioral Health in Rural and Underserved Areas
  Journal Article
  Rural Telehealth Research Center
  Date: 11/2019
  This paper describes how two distinct tele-emergency department (ED) behavioral health models address challenges in access and placement for patients in rural and underserved areas presenting to EDs. The notable difference in disposition rates between cases and controls shows the impact each model is having on care practices and processes.
• Using CPT Charges as an Economic Proxy for Telehealth and Non-Telehealth Emergency Department Utilization
  Policy Brief
  Rural Telehealth Research Center
  Date: 11/2021
  This brief examines economic data on emergency department visits from unrelated rural hospitals. By using the reported Current Procedural Terminology code and associated charge, we explore the characteristics of the resulting dataset in terms of distribution and association with related variables.