{"doi":"10.1101/2022.06.02.22275922","title":"Outcomes Associated with Rural Emergency Department Provider-to-Provider Telehealth for Sepsis Care: A Multicenter Cohort Study","abstract":"ABSTRACT Objective To test the hypothesis that provider-to-provider tele-emergency department (tele-ED) care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments (EDs). Methods Multicenter (n=23), propensity-matched, cohort study using medical records of sepsis patients from rural hospitals in a well-established, on-demand, rural video tele-ED network in the upper Midwest between August 2016 and June 2019. The primary outcome was 28-day hospital-free days, with secondary outcomes of 28-day in-hospital mortality and SSC guideline adherence. Results A total of 1,191 patients were included in the analysis, with tele-ED used for 326 (27%). Tele-ED cases were more likely to be transferred to another hospital (88% vs. 8%, difference 79%, 95% CI 75–83%). After matching and regression adjustment, tele-ED cases did not have more 28-day hospital-free days (difference 0.80 days longer for non-tele-ED, 95% confidence interval [CI] [-0.87]–2.47) or 28-day in-hospital mortality (adjusted odds ratio [aOR] 1.61, 95% CI 0.74-3.57). Adherence with both the SSC 3-hour bundle (aOR 0.80, 95% CI 0.24– 2.70) and complete bundle (aOR 0.81, 95% CI 0.15–4.41) were similar. An a priori –defined subgroup analysis of patients treated by advanced practice providers suggested that the mortality was lower in the cohort with tele-ED use (aOR 0.19, 95% CI 0.04–0.90) despite no significant difference in complete SSC bundle adherence (aOR 2.48, 95% CI 0.45–13.76). Conclusions Rural ED patients treated with provider-to-provider tele-ED care in a mature network appear to have similar clinical outcomes to those treated without.","journal":"medRxiv","year":2022,"id":309010,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9312,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":914032,"name":"Uche Okoro","orcid":null,"position":1,"is_corresponding":false},{"id":411328,"name":"Karisa K. Harland","orcid":"0000-0001-9482-8447","position":2,"is_corresponding":false},{"id":512233,"name":"Brian M. Fuller","orcid":"0000-0003-3757-756X","position":3,"is_corresponding":false},{"id":914033,"name":"Kalyn Campbell","orcid":null,"position":4,"is_corresponding":false},{"id":411350,"name":"Morgan B. Swanson","orcid":"0000-0003-0558-4191","position":5,"is_corresponding":false},{"id":914034,"name":"Cole Wymore","orcid":null,"position":6,"is_corresponding":false},{"id":411338,"name":"Brett Faine","orcid":"0000-0002-5759-9857","position":7,"is_corresponding":false},{"id":616163,"name":"Anne Zepeski","orcid":"0000-0001-6309-6554","position":8,"is_corresponding":false},{"id":654392,"name":"Edith A. Parker","orcid":null,"position":9,"is_corresponding":false},{"id":913510,"name":"Luke Mack","orcid":"0000-0003-1253-8257","position":10,"is_corresponding":false},{"id":913511,"name":"Amanda Bell","orcid":"0000-0002-9920-565X","position":11,"is_corresponding":false},{"id":914035,"name":"Katie DeJong","orcid":null,"position":12,"is_corresponding":false},{"id":913512,"name":"Keith J. Mueller","orcid":"0000-0002-6533-3303","position":13,"is_corresponding":false},{"id":610824,"name":"Elizabeth A. Chrischilles","orcid":"0000-0002-1843-1955","position":14,"is_corresponding":false},{"id":512237,"name":"Christopher R. Carpenter","orcid":"0000-0002-2603-7157","position":15,"is_corresponding":false},{"id":412581,"name":"Kelli Wallace","orcid":null,"position":16,"is_corresponding":false},{"id":1003763,"name":"Michael P. Jones","orcid":"0000-0003-2255-4058","position":17,"is_corresponding":false},{"id":455383,"name":"Marcia M. Ward","orcid":"0000-0003-1948-1302","position":18,"is_corresponding":false},{"id":411327,"name":"Nicholas M. Mohr","orcid":"0000-0003-0497-5828","position":0,"is_corresponding":true}],"reference_count":60,"raw_metadata":null,"created_at":"2026-07-19T00:33:07.132912Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}