Abstract
Background
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2010 Summary Tables.
Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables.
- 65+ in the United States: 2010.U.S. Government Printing Office, Washington, DC2014
- Transforming emergency care for older adults.Health Aff (Millwood). 2013; 32: 2116-2121
- Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003.Ann Emerg Med. 2008; 51: 769-774
- Where Americans get acute care: Increasingly, it's not at their doctor's office.Health Aff (Millwood). 2010; 29: 1620-1629
- Access to Health Care in America.in: Millman M. National Academy Press, Washington, DC1993
- Access to health care and hospitalizations for ambulatory care sensitive conditions.Med Care Res Rev. 2006; 63: 719-741
- Ambulatory care sensitive hospitalizations and emergency department visits in Baltimore City.Rand Corporation, Santa Monica, CA2009
- Impact of socioeconomic status on hospital use in New York City.Health Aff. 1993; 12: 162-173
- Socioeconomic variations in asthma hospitalization: Excess utilization or greater need?.Pediatrics. 1999; 103: e75
- Trends in emergency department visits for ambulatory care sensitive conditions by elderly nursing home residents, 2001 to 2010.JAMA Intern Med. 2014; 174: 156-158
- Disparities in potentially avoidable emergency department care.Med Care. 2012; 50: 1020-1028
- ED visits by older adults for ambulatory care-sensitive and supply-sensitive conditions.Am J Emerg Med. 2006; 24: 428-434
- Potential of telemedicine to provide acute medical care for adults in senior living communities.Acad Emerg Med. 2013; 20: 162-168
- The impact of telehealthcare on the quality and safety of care: A systematic overview.PLoS One. 2013; 8: e71238
- Virtual visits—Confronting the challenges of telemedicine.N Engl J Med. 2015; 372: 1684-1686
- Telehealth can bridge the gap for rural, disabled, and elderly patients.J Am Med Dir Assoc. 2015; 16: 268-269
- Effectiveness of telemedicine in replacing in-person evaluation for acute childhood illness in office settings.Telemed J E Health. 2006; 12: 308-316
- Acute illness care patterns change with use of telemedicine.Pediatrics. 2009; 123: e989-e995
- Telemedicine in urban and suburban childcare and elementary schools lightens family burdens.Telemed J E Health. 2010; 16: 533-542
Shah MN, Wasserman EB, Wang H, et al. High-intensity telemedicine decreases emergency department use by senior living community residents. Telemed J E Health 2015 Aug 7. [Epub ahead of print].
- A qualitative evaluation of a telemedicine-enhanced emergency care program for older adults.J Am Geriatr Soc. 2013; 61: 571-576
- High-intensity telemedicine-enhanced acute care for older adults: An innovative healthcare delivery model.J Am Geriatr Soc. 2013; 61: 2000-2007
- Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for Medicare.Health Aff (Millwood). 2014; 33: 244-250
- Telemedicine: A pilot study in nursing home residents.Gerontology. 2001; 47: 82-87
- Use of a self-report-generated Charlson Comorbidity Index for predicting mortality.Med Care. 2005; 43: 607-615
- Longitudinal data analysis for discrete and continuous outcomes.Biometrics. 1986; 42: 121-130
- More may be better: Evidence of a negative relationship between physician supply and hospitalization for ambulatory care sensitive conditions.Health Serv Res. 2005; 40: 1148-1166
- The effect of cognitive impairment on the accuracy of the presenting complaint and discharge instruction comprehension in older emergency department patients.Ann Emerg Med. 2011; 57: 662-671.e662
- Prevalence of information gaps in the emergency department and the effect on patient outcomes.CMAJ. 2003; 169: 1023-1028
- Noise in the ED.Am J Emerg Med. 2005; 23: 332-335
- Noise in the adult emergency department of Johns Hopkins Hospital.J Acoust Soc Am. 2007; 121: 1996-1999
- The geriatric emergency department.J Am Geriatr Soc. 2007; 55: 1873-1876
- Is cognitive function a concern in independent elderly adults discharged home from the emergency department in Canada after a minor injury.J Am Geriatr Soc. 2014; 62: 2130-2135
- Large proportion of frail independent older patients with cognitive impairment show functional decline after emergency department visits for minor injuries.J Nutr Health Aging. 2013; 17: S602
- Cumulative incidence of functional decline after minor injuries in previously independent older Canadian individuals in the emergency department.J Am Geriatr Soc. 2013; 61: 1661-1668
Article info
Publication history
Published online: August 17, 2015
Footnotes
This project was supported by grant number R01HS018047 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
Two of the authors, Dr. K.M.M. and N.E.W., were eligible to receive royalties while this research was active from Trifecta Technologies, which develops and maintains the software used in the study. They were no longer eligible to receive royalties as of December 31, 2013. Dr. M.N.S. was a consultant to Fortress Investment Group and one of their companies, Lifeline2Care, which was, but no longer is, developing a senior living community telemedicine model.
Identification
Copyright
© 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
