{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T01:49:50Z","timestamp":1781574590334,"version":"3.54.5"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T00:00:00Z","timestamp":1610409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["HHSH250201300018I\/HHSH25034002T"],"award-info":[{"award-number":["HHSH250201300018I\/HHSH25034002T"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010001","name":"Federal Office of Rural Health Policy","doi-asserted-by":"publisher","award":["U1CRH29074"],"award-info":[{"award-number":["U1CRH29074"]}],"id":[{"id":"10.13039\/100010001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["GO1RH27868, G01RH27870, G01RH27871, G01RH27872, Grant No. G01RH27873, and G01RH27869"],"award-info":[{"award-number":["GO1RH27868, G01RH27870, G01RH27871, G01RH27872, Grant No. G01RH27873, and G01RH27869"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>The Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy (FORHP) funded the Evidence-Based Tele-Emergency Network Grant Program (EB TNGP) to serve the dual purpose of providing telehealth services in rural emergency departments (teleED) and systematically collecting data to inform the telehealth evidence base. This provided a unique opportunity to examine trends across multiple teleED networks and examine heterogeneity in processes and outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Method and findings<\/jats:title><jats:p>Six health systems received funding from HRSA under the EB TNGP to implement teleED services and they did so to 65 hospitals (91% rural) in 11 states. Three of the grantees provided teleED services to a general patient population while the remaining three grantees provided teleED services to specialized patient populations (i.e., stroke, behavioral health, critically ill children). Over a 26-month period (November 1, 2015 \u2013December 31, 2017), each grantee submitted patient-level data for all their teleED encounters on a uniform set of measures to the data coordinating center. The six grantees reported a total of 4,324 teleED visits and 99.86% were technically successful. The teleED patients were predominantly adult, White, not Latinx, and covered by Medicare or private insurance. Across grantees, 7% of teleED patients needed resuscitation services, 58% were rated as emergent, and 30% were rated as urgent. Across grantees, 44.2% of teleED patients were transferred to another inpatient facility, 26.0% had a routine discharge, and 24.5% were admitted to the local inpatient facility. For the three grantees who served a general patient population, the most frequent presenting complaints for which teleED was activated were chest pain (25.7%), injury or trauma (17.1%), stroke symptoms (9.9%), mental\/behavioral health (9.8%), and cardiac arrest (9.5%). The teleED consultation began before the local clinician exam in 37.8% of patients for the grantees who served a general patient population, but in only 1.9% of patients for the grantees who provided specialized services.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions<\/jats:title><jats:p>Grantees used teleED services for a representative rural population with urgent or emergent symptoms largely resulting in transfer to a distant hospital or inpatient admission locally. TeleED was often available as the first point of contact before a local provider examination. This finding points to the important role of teleED in improving access for rural ED patients.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0243211","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T23:09:08Z","timestamp":1610492948000},"page":"e0243211","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["HRSA\u2019s evidence-based tele-emergency network grant program: Multi-site prospective cohort analysis across six rural emergency department telemedicine networks"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3553-5796","authenticated-orcid":true,"given":"Sarah","family":"Heppner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0497-5828","authenticated-orcid":true,"given":"Nicholas M.","family":"Mohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6710-4029","authenticated-orcid":true,"given":"Knute D.","family":"Carter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Ullrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A. S.","family":"Merchant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia M.","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,12]]},"reference":[{"key":"pone.0243211.ref001","volume-title":"Urban and Rural Classification and Urban Areas Criteria","year":"2010"},{"issue":"2","key":"pone.0243211.ref002","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1377\/hlthaff.2013.1016","article-title":"Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems","volume":"33","author":"KJ Mueller","year":"2014","journal-title":"Health Affairs"},{"issue":"2","key":"pone.0243211.ref003","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.injury.2017.01.008","article-title":"Disparities in access to trauma care in the United States: A population-based analysis","volume":"48","author":"BG Carr","year":"2017","journal-title":"Injury"},{"issue":"6","key":"pone.0243211.ref004","doi-asserted-by":"crossref","first-page":"S199","DOI":"10.1016\/j.amepre.2018.01.004","article-title":"Geographic variation in the supply of selected behavioral health providers","volume":"54","author":"CHA Andrilla","year":"2018","journal-title":"American Journal of Preventive Medicine"},{"issue":"2","key":"pone.0243211.ref005","doi-asserted-by":"crossref","first-page":"186","DOI":"10.5811\/westjem.2012.8.12783","article-title":"Board-certified emergency physicians comprise a minority of the emergency department workforce in Iowa","volume":"14","author":"H Groth","year":"2013","journal-title":"The Western Journal of Emergency Medicine"},{"issue":"3","key":"pone.0243211.ref006","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.annemergmed.2018.03.032","article-title":"State of the national emergency department workforce: Who provides care where?","volume":"72","author":"MK Hall","year":"2018","journal-title":"Annals of Emergency Medicine"},{"issue":"6","key":"pone.0243211.ref007","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1097\/PCC.0000000000000761","article-title":"Impact of telemedicine on severity of illness and outcomes among children transferred from referring emergency departments to a children\u2019s hospital PICU","volume":"17","author":"P Dayal","year":"2016","journal-title":"Pediatric Critical Care Medicine"},{"issue":"1","key":"pone.0243211.ref008","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1357633X17734239","article-title":"Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: A systematic review","volume":"25","author":"M du Toit","year":"2019","journal-title":"Journal of Telemedicine and Telecare"},{"issue":"12","key":"pone.0243211.ref009","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1097\/PEC.0000000000001067","article-title":"A qualitative analysis of general emergency medicine providers\u2019 perceptions on pediatric emergency telemedicine","volume":"35","author":"JW Kim","year":"2019","journal-title":"Pediatric Emergency Care"},{"issue":"3","key":"pone.0243211.ref010","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1089\/tmj.2017.0083","article-title":"Telemedicine use decreases rural emergency department length of stay for transferred North Dakota trauma patients","volume":"24","author":"NM Mohr","year":"2018","journal-title":"Telemedicine Journal and e-Health"},{"issue":"8","key":"pone.0243211.ref011","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1089\/tmj.2017.0262","article-title":"Emergency department telemedicine shortens rural time-to-provider and emergency department transfer times","volume":"24","author":"NM Mohr","year":"2018","journal-title":"Telemedicine Journal and e-Health"},{"issue":"9","key":"pone.0243211.ref012","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.ijmedinf.2015.05.009","article-title":"Systematic review of telemedicine applications in emergency rooms","volume":"84","author":"MM Ward","year":"2015","journal-title":"International Journal of Medical Informatics"},{"key":"pone.0243211.ref013","unstructured":"IOM (Institute of Medicine). The role of telehealth in an evolving health care environment: Workshop summary. Washington, DC: The National Academies Press. 2012"},{"issue":"7","key":"pone.0243211.ref014","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1089\/tmj.2016.0190","article-title":"Building the evidence base for tele-emergency care: Efforts to identify a standardized set of outcome measures","volume":"23","author":"Y Harris","year":"2017","journal-title":"Telemedicine Journal and e-Health"},{"key":"pone.0243211.ref015","unstructured":"Ward MM, Ullrich F, Merchant KAS, Mohr NM, Weigel P, MacKinney AC, et al. Identifying measures and data elements for the HRSA Evidence-Based Tele-Emergency Network Grant Program. RTRC Research & Policy Brief. March 2020"},{"issue":"1","key":"pone.0243211.ref016","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jen.2003.11.004","article-title":"The Emergency Severity Index (version 3) 5-level triage system scores predict ED resource consumption","volume":"30","author":"P Tanabe","year":"2004","journal-title":"Journal of Emergency Nursing"},{"issue":"3","key":"pone.0243211.ref017","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1111\/j.1553-2712.2000.tb01066.x","article-title":"Reliability and validity of a new five-level triage instrument","volume":"7","author":"RC Wuerz","year":"2000","journal-title":"Academic Emergency Medicine"},{"key":"pone.0243211.ref018","volume-title":"Emergency Severity Index (ESI): A triage tool for emergency department care, Version 4. Implementation handbook 2012 edition","author":"N Gilboy","year":"2011"},{"key":"pone.0243211.ref019","unstructured":"AHA Annual Survey Database, 2015 ed. Chicago, IL: American Hospital Association, 2016."},{"issue":"7","key":"pone.0243211.ref020","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.2105\/AJPH.2004.042432","article-title":"Rural definitions for health policy and research","volume":"95","author":"LG Hart","year":"2005","journal-title":"American Journal of Public Health"},{"issue":"7624","key":"pone.0243211.ref021","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"E von Elm","year":"2007","journal-title":"BMJ (Clinical research ed)"},{"issue":"9","key":"pone.0243211.ref022","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1089\/tmj.2013.0348","article-title":"Telestroke in an urban setting","volume":"20","author":"S Cutting","year":"2014","journal-title":"Telemedicine Journal and e-Health"},{"key":"pone.0243211.ref023","volume-title":"Emergency Services and Telemedicine: Implications for Emergency Services Condition of Participation (CoPs) and EMTALA On-Call Compliance","author":"Critical Access Hospital (CAH)","year":"2013"},{"issue":"12","key":"pone.0243211.ref024","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1377\/hlthaff.2018.05103","article-title":"Use of telemedicine for ED physician coverage in critical access hospitals increased after CMS policy clarification","volume":"37","author":"MM Ward","year":"2018","journal-title":"Health Affairs (Project Hope)"},{"key":"pone.0243211.ref025","volume-title":"Creating a Framework to Support Measure Development for Telehealth","author":"J Hollander","year":"2017"},{"issue":"1","key":"pone.0243211.ref026","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/1357633X15586319","article-title":"Tele-emergency utilization: In what clinical situations is tele-emergency activated?","volume":"22","author":"MM Ward","year":"2016","journal-title":"Journal of Telemedicine and Telecare"},{"issue":"6","key":"pone.0243211.ref027","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1177\/1357633X16657499","article-title":"The impact of the TelEmergency program on rural emergency care: An implementation study","volume":"23","author":"SA Sterling","year":"2017","journal-title":"Journal of Telemedicine and Telecare"},{"issue":"2","key":"pone.0243211.ref028","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/acem.13120","article-title":"Emergency department telemedicine is used for more severely injured rural trauma patients, but does not decrease transfer: A cohort study","volume":"24","author":"NM Mohr","year":"2017","journal-title":"Academic Emergency Medicine"},{"issue":"2","key":"pone.0243211.ref029","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1089\/tmj.2017.0035","article-title":"Evaluation of a French regional telemedicine network dedicated to neurological emergencies: A 14-Year Study","volume":"24","author":"E Medeiros de Bustos","year":"2018","journal-title":"Telemedicine Journal and e-Health"},{"issue":"2","key":"pone.0243211.ref030","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1089\/tmj.2018.0013","article-title":"Telemedicine is associated with faster diagnostic imaging in stroke patients: A cohort study","volume":"25","author":"NM Mohr","year":"2019","journal-title":"Telemedicine Journal and e-Health"},{"issue":"4","key":"pone.0243211.ref031","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1080\/10903127.2017.1408728","article-title":"Effects of telestroke on thrombolysis times and outcomes: A meta-analysis","volume":"22","author":"A Baratloo","year":"2018","journal-title":"Prehospital Emergency Care"},{"key":"pone.0243211.ref032","article-title":"Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort","author":"MB Swanson","year":"2019","journal-title":"Journal of Telemedicine and Telecare"},{"key":"pone.0243211.ref033","article-title":"Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments","author":"NM Mohr","year":"2020","journal-title":"Journal of Telemedicine and Telecare"},{"key":"pone.0243211.ref034","article-title":"Emergency department telemedicine consults are associated with faster time-to-ECG and time-to fibrinolysis for myocardial infarction patients","author":"AC Miller","year":"2020","journal-title":"Telemedicine and e-Health"},{"key":"pone.0243211.ref035","article-title":"Averted transfers in rural emergency departments using telemedicine: Rates and costs across six teleED networks","author":"MM Ward","year":"2020","journal-title":"Telemedicine and e-Health"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0243211","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T12:41:56Z","timestamp":1697546516000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0243211"}},"subtitle":[],"editor":[{"given":"Abhishek","family":"Makkar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,1,12]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0243211","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,12]]}}}