Digital emergency routing: analysis of feasibility, utilization, and equity implications

Area of Science:

• Digital Health
• Health Services Research
• Emergency Medicine

Background:

• Digital emergency care applications show promise for improving efficiency and coordination.
• Limited evidence exists on the large-scale, real-world implementation of these technologies.
• Maccabi Healthcare Services developed Maccabi-RED, a mobile app for urgent community-based care as an alternative to emergency departments.

Purpose of the Study:

• To examine the implementation and utilization of the Maccabi-RED application from 2020-2023.
• To describe patient demographics and clinical characteristics for emergency care requests.
• To identify factors influencing request approval and successful routing to community care, and analyze subsequent healthcare utilization.

Main Methods:

• A retrospective analysis of de-identified electronic health records from Maccabi Healthcare Services.
• Inclusion of 94,795 patient-initiated emergency care requests via the Maccabi-RED app (January 2020 - December 2023).
• Extraction of demographic, clinical variables, and analysis of 7-day post-request healthcare utilization, comparing approved vs. non-approved requests.

Main Results:

• Over 51% of requests were approved, leading to community clinic appointments, with a significant increase in utilization from 2020 to 2023.
• Approved requests were more frequent in older patients and those with chronic conditions; approval rates varied by emergency type and showed disparities across geographic, ethnic, and socioeconomic groups.
• Approved requests correlated with reduced 7-day healthcare utilization, including fewer primary care visits and lower emergency department/medical center visits.

Conclusions:

• The Maccabi-RED app demonstrates feasibility for scaled digital emergency care routing, potentially decreasing acute care use.
• Observed disparities in approval rates across demographics indicate that digital maturity alone does not ensure equitable access.
• Future digital health developments must prioritize equity, transparency, and algorithmic fairness to prevent exacerbating existing health inequities.