Differential Associations of Outpatient and Office-Based Telehealth Visits with Emergency Department Visits among U.S. Adults: A National Cross-Sectional Study

Background and Objectives: The increased utilization of emergency departments (EDs) for non-emergent conditions places a significant strain on healthcare systems. Telehealth offers a potential alternative for managing acute and chronic conditions, possibly reducing avoidable ED visits. We aimed to examine the association between telehealth visits and ED use among U.S. adults, with a focus on setting-specific differences. Methods: We conducted a cross-sectional analysis using data from the 2022 Medical Expenditure Panel Survey. Adults aged >=18 years were included (N = 17,328; Weighted N=~257 million). Telehealth use was categorized based on outpatient clinic and office-based provider visits. The primary outcome was the number of ED visits in the past 12 months. We used survey-weighted generalized linear models with a Poisson distribution to estimate incident rate ratios (IRRs), adjusting for sociodemographic, health, behavioral, and social determinants of health factors. Results: Overall, 14.0% reported telehealth use. In unadjusted analyses, both outpatient (IRR = 1.04; 95% CI [1.02-1.06]; p = 0.0002) and office-based (IRR = 1.01; 95% CI [1.00-1.02]; p = 0.0214) telehealth visits were significantly associated with greater emergency department utilization. However, in the fully adjusted model including demographic, clinical, and behavioral covariates, the outpatient association remained significant (IRR = 1.03; 95% CI [1.01-1.04]; p = 0.0039), while the office-based association remained non-significant (IRR = 1.00; 95% CI [0.99-1.01]; p = 0.58). Conclusions: Our study findings highlight the importance of delivery context in telehealth design and implementation to optimize healthcare resource use.