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Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study
  1. Jayamalathi Priyanka Vakkalanka1,2,
  2. Karisa K Harland1,2,
  3. Amy Wittrock3,
  4. Margaret Schmidt3,
  5. Luke Mack3,
  6. Matthew Nipe3,
  7. Elaine Himadi4,
  8. Marcia M Ward5,
  9. Nicholas M Mohr1,2,6
  1. 1Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  2. 2Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
  3. 3Avera eCARE, Sioux Falls, South Dakota, USA
  4. 4Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  5. 5Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
  6. 6Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  1. Correspondence to Jayamalathi Priyanka Vakkalanka, Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; vakkalanka{at}


Objective The purpose of this study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt.

Methods Retrospective propensity-matched cohort study of patients treated for suicidal attempt and ideation in 13 rural critical access hospital EDs participating in a telemedicine network. Patients for whom telemedicine was used were matched 1:1 to those who did not have telemedicine as an exposure (n=139 TM+, n=139 TM–) using optimal matching of propensity scores based on administrative data. Our primary outcome was ED length-of-stay (LOS), and secondary outcomes included admission proportion, use of chemical or physical restraint, 30 day ED return, involuntary detention orders, treatment/follow-up plan and 6-month mortality. Analyses for multivariable models were conducted using conditional linear and logistic regression clustered on matched pairs with purposeful selection of covariates.

Results Mean ED LOS was not associated with telemedicine consultation among all patients, but was associated with a 29.3% decrease in transferred patients (95% CI 11.1 to 47.5). The adjusted odds of hospital admission (either local or through transfer) was 2.35 (95% CI 1.10 to 5.00) times greater among TM+ patients compared with TM– patients. Involuntary hold placement was lower in those exposed to telemedicine (adjusted odds ratio (aOR): 0.48; 95% CI 0.23 to 0.97). We did not observe significant differences in other outcomes.

Conclusion The role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments.

  • Telemedicine
  • Suicide
  • Emergency Service, Hospital
  • Rural Health Services
  • Patient Outcome Assessment
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  • Contributors JPV, NMM, KKH, EH and MMW designed the study. AW and MS extracted and managed the data, and JPV analysed the data with NMM and KKH. JPV, KKH and NMM drafted the manuscript, and all authors contributed to its revision.

  • Funding This project was supported by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) (Grant No. G01RH27868, ‘Evidence-Based Tele-Emergency Network Grant Programme’ and Grant No. 6 UICRH29074-01-01, ‘Telehealth-Focused Rural Health Research Centre’). NMM is additionally supported by Grant No. K08-HS025753 from the Agency for Healthcare Research and Quality (AHRQ).

  • Disclaimer The content of the article is solely the responsibility of the authors and does not necessarily represent the official views of HRSA or AHRQ.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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