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

Digital emergency care applications offer potential to reduce delays, enhance triage, and improve care coordination, yet evidence remains limited on their real-world implementation at scale. Maccabi Healthcare Services developed Maccabi-RED, a mobile application allowing patients to request urgent community-based care as an alternative to hospital emergency department visits. This study examines the implementation and utilization of Maccabi-RED during 2020-2023, aiming to describe demographic and clinical characteristics of patients initiating emergency care requests, identify factors associated with request approval and successful routing to community-based care and examine healthcare utilization patterns following app-initiated requests.

This retrospective study analyzed de-identified electronic health record data from Maccabi Healthcare Services, including all patient-initiated emergency care requests through the Maccabi-RED application between January 2020 and December 2023. The study included 94,795 requests from 77,508 patients. We extracted demographic and clinical variables and examine patterns of subsequent healthcare utilization in the week following app-initiated emergency care requests, comparing approved versus non-approved requests.

During the study period, 51.6% of requests were approved, resulting in urgent community clinic appointments. Service utilization increased substantially from 11,058 requests in 2020 to 36,532 in 2023. Approved requests were more common among older patients and those with chronic conditions. Emergency type strongly influenced approval rates, with foreign body cases showing substantially higher approval odds than orthopedic cases. Geographic, ethnic, and socioeconomic disparities in approval rates were observed. In adjusted analyses, approved requests were associated with lower 7-day healthcare utilization, including fewer primary care physician visits and reduced odds of hospital emergency department and emergency medical center visits.

The Maccabi-RED application demonstrates feasibility of scaling patient-initiated digital emergency routing, with potential to reduce downstream acute care utilization. However, observed approval disparities across age groups, geographic regions, and socioeconomic strata indicate that digital maturity alone does not guarantee equitable access. These findings underscore the importance of embedding equity considerations in system design, monitoring protocols, and capacity planning. Future development, including artificial intelligence-enabled decision support, should prioritize transparency and algorithmic fairness to improve performance without amplifying existing health inequities.