Hybrid Telemedicine–House-Call Model for Pneumonia Management in North Texas: Retrospective Pilot Study

BACKGROUND: Pneumonia accounts for approximately 1.4 million emergency department (ED) visits annually in the United States. Hybrid care models integrating telemedicine with in-home clinical support may offer a novel approach to managing appropriately selected patients while optimizing ED use. OBJECTIVE: This study aimed to evaluate a hybrid house-call model for managing adults with pneumonia by describing patient characteristics, use patterns, illness severity, and ED referral rates. METHODS: We conducted a retrospective descriptive case-series study among adults diagnosed with pneumonia within a primary and urgent care system between January 1, 2022, and January 1, 2024. Cases were identified using the International Classification of Diseases, 10th Revision (ICD-10) codes (J18.9, J15.8, J16.8, J17, and J18.1). In total, 30 patient records were screened, and 28 met the eligibility criteria for analysis. The hybrid model combined virtual physician evaluation with in-home assessment by a trained health care professional using digital diagnostic tools. Data collected included visit type, treatments, comorbidities, CRB-65 (confusion, respiratory rate, blood pressure, age ≥65 years) scores, and ED referrals. Differences between patients referred to the ED and those who were not referred to the ED were evaluated using the Mann-Whitney U test. RESULTS: In total, 28 patients accounted for 56 clinical encounters (median 2, IQR 1-3 encounters per patient). CRB-65 scores ranged from 0 to 2, with 13 (46.4%) patients scoring 0, 13 (46.4%) patients scoring 1, and 2 (7.1%) patients scoring 2. Of the 28 patients, 8 (28.6%) were referred to the ED. Patients referred to the ED had significantly higher CRB-65 scores than those managed without ED referral (median 1, IQR 1-1.5 vs median 0, IQR 0-1; Mann-Whitney U=34.0; P=.01). CONCLUSIONS: This retrospective descriptive case-series study demonstrates the implementation of a hybrid telemedicine-house-call model for adults with pneumonia in a real-world clinical setting. Larger prospective comparative studies with longitudinal follow-up are needed to evaluate clinical outcomes, referral performance, safety, and effectiveness.