High-Intensity Telemedicine Decreases Emergency Department Use for Ambulatory Care Sensitive Conditions by Older Adult Senior Living Community Residents

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• 作者：Manish N. Shah ; MD ; MPH^a ; ^b ; ^c ; ^{mnshah@medicine.wisc.edu" class="auth_mail" title="E-mail the corresponding author} ; Erin B. Wasserman ; PhD^a ; ^b ; Suzanne M. Gillespie ; MD ; RD^a ; ^c ; ^{suzanne_gillespie@urmc.rochester.edu" class="auth_mail" title="E-mail the corresponding author} ; Nancy E. Wood ; MS^a ; Hongyue Wang ; PhD^d ; Katia Noyes ; PhD ; MPH^b ; ^e ; Dallas Nelson ; MD^c ; Ann Dozier ; PhD^b ; Kenneth M. McConnochie ; MD ; MPH^f
• 关键词：Aging ; telemedicine ; acute illness ; ambulatory care sensitive conditions
• 刊名：Journal of the American Medical Directors Association
• 出版年：2015
• 出版时间：1 December 2015
• 年：2015
• 卷：16
• 期：12
• 页码：1077-1081
• 全文大小：231 K

文摘

Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) are common among older adults. The high-intensity telemedicine model of care has been proposed as an innovative approach to expand access to acute illness care, thereby preventing ED visits. The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of ED use for ACSCs.

Methods

We performed a prospective cohort study at a primary care geriatrics practice that provides care to 22 SLCs. Six SLCs selected as intervention facilities, with the remaining SLCs serving as controls. Consenting practice patients at intervention facilities could have patient-to-provider, real-time, or store-and-forward high-intensity telemedicine services to diagnose and treat illnesses. The primary outcome was the rate of ED visits for which the primary diagnosis was an “ambulatory-care-sensitive” condition by the Institute of Medicine, which we compared between control and intervention participants.

Results

During the study period, control participants had 310 ED visits for ACSCs, for a rate of 0.195 visits/person-year. Intervention participants visited the ED for ACSCs 85 times, for a rate of 0.138 visits/person-year [unadjusted rate ratio (RR): 0.71, 95% confidence interval (CI): 0.53–0.94]. Among intervention participants, ED use for ACSCs decreased at an annual rate of 34% (RR: 0.661, 95% CI: 0.444–0.982), whereas, in the control group there was no statistically significant change in ED use over time (RR: 1.01, 95% CI: 0.90–1.14).

Conclusions

Providing acute illness care by high-intensity telemedicine to older adults residing in SLCs significantly decreases the rate of ED use for ACSCs over 1 year, compared with no change in the rate of ED use for ACSCs among the control group.