Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Background: Asynchronous care has emerged as a promising approach to improving healthcare accessibility while potentially reducing costs, particularly for low-acuity conditions. Our objective was to describe the use patterns, patient characteristics, and short-term clinical outcomes of an emergency department (ED)–led asynchronous care platform managing low-acuity conditions in a large, academic health system.

Methods: We conducted a retrospective cohort study evaluating the Mount Sinai Health System asynchronous care platform for managing urinary tract infections, conjunctivitis, cold sores, vaginal candidiasis, emergency contraception, and oral contraceptive prescriptions between December 2023–October 2024 during an initial rollout period. Individual charts were reviewed by two trained abstractors and two emergency physicians. The primary outcome was any subsequent ED or clinic visit within seven days. Secondary outcomes included change in diagnosis and medication at relevant follow-up visits. We used descriptive statistics to characterize the cohort and outcomes. 

Results: During the study period, there were 19,204 ED encounters for conditions matching asynchronous care chief complaint categories, of which 343 encounters (1.8%) from 277 unique patients were managed via the asynchronous care platform. The median patient age was 32.6 years (interquartile range IQR 28.3–41.2), and 258 (93.1%) were female. Overall chief complaints included cystitis/urinary complaints in 157 (45.8%) encounters, conjunctivitis/eye complaints in 57 (16.6%), and vaginal/vulvar candidiasis in 96 (28.0%). At the encounter level, 18 (5.2%) were up-triaged from the asynchronous care platform to synchronous virtual urgent care or in-person evaluation after initial screening. We observed the primary outcome of a subsequent ED or clinic visit within seven days in 68 patients (24.5%). Five patients (1.5%; 95% CI, 0.5-3.5%) were identified with a change in diagnosis within the seven-day outcome window, with all diagnostic changes occurring within 1-3 days of the index asynchronous care encounter (median one day).

Conclusion: In this single-center study, an asynchronous care platform demonstrated a viable pathway for managing select low-acuity conditions in an urban academic health system. This structured platform, with appropriate triage pathways and low rates of diagnostic discordance, shows promise as a model to expand access to care for select low-acuity complaints.