Accepted for/Published in: JMIR Formative Research
Date Submitted: Apr 18, 2026
Date Accepted: Aug 11, 2026
Hybrid Telemedicine–House Call Model for Pneumonia Management in North Texas: A Retrospective Pilot Study
ABSTRACT
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 low-acuity cases while optimizing ED utilization
Objective:
To evaluate the feasibility of a hybrid house-call model in managing pneumonia and its potential to reduce ED utilization while maintaining appropriate triage of higher-risk patients.
Methods:
We conducted a retrospective review of patients diagnosed with pneumonia across a primary and urgent care system between January 1, 2022, and January 1, 2024. Cases were identified using International Classification of Diseases (ICD-10) codes (J18.9, J15.8, J16.8, J17, J18.1). The hybrid model consisted of virtual physician evaluation combined with in-home assessment by a medical assistant using digital diagnostic tools, including a stethoscope. Data collected included visit type, treatment, comorbidities, CURB-65 scores, and ED referrals. Differences in acuity between patients referred and not referred to the ED were analyzed using the Mann–Whitney U test.
Results:
Thirty patients accounted for 57 hybrid visits (mean 1.9 visits per patient). The mean CURB-65 score across all visits was 1.65, consistent with low to moderate severity. Eight patients, all with significant comorbidities, were referred to the ED. Patients referred to the ED had significantly higher acuity scores compared to those managed at home (5.34 vs 1.44, P=.002). The hybrid model was associated with an estimated $42,000 in avoided ED costs, based on average ED visit expenditures.
Conclusions:
This pilot evaluation suggests that a hybrid telemedicine–house call model is a feasible approach for managing low-acuity pneumonia and may reduce ED utilization while preserving appropriate escalation for higher-risk patients. Further prospective studies are needed to validate these findings and assess scalability. Clinical Trial: Not applicable
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