Effectiveness and cost-effectiveness of a telemedicine programme for preventing unplanned hospitalisations of older adults living in nursing homes: the GERONTACCESS cluster randomized clinical trial

Abstract

Objective The GERONTACCESS trial evaluated the utility and cost-effectiveness of a gerontological telemedicine (TLM) programme for preventing unplanned hospitalisation of residents living in nursing homes (NHs) in regions lacking medical facilities and/or qualified medical providers (“medical deserts”). Design GERONTACCESS was a 12-month, multicentre, prospective cluster-randomised trial conducted in NHs. The intervention group underwent TLM assessments every 3 months. The control group received the usual care. In both groups, comprehensive on-site assessments were conducted at baseline and the final visit. Care requirements were documented throughout the study. Setting and participants NH residents aged ≥ 60 years with multiple chronic diseases. Methods The study outcomes were the proportion of patients who experienced avoidable and unplanned hospitalisation, and the incremental cost savings per quality-adjusted life years from baseline to the 12-month follow-up. Results Of the 426 randomised participants (mean ± standard deviation age, 87.2 ± 7.6 years; 311 [73.0%] women), 23.4% in the intervention group and 32.5% in the control group experienced unplanned hospitalisation (odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.43 to 0.97; p = 0.034). Each avoided hospitalisation in the intervention group saved $US 3,846. Conclusions and implications The results of GERONTACCESS revealed that our gerontological, preventative TLM program significantly reduced unplanned hospitalisations. This innovative intervention limited disease progression and promoted a healthy lifestyle among NH residents. Trial registration Clinicaltrials.gov, NCT02816177, registered June 28, 2016.

Remote Monitoring System for Older Adults at Risk for Complications: A Scoping Review

“…Results on LOS showed no signi cant reduction, except in the study by Mudiyanselage et al, [42], when hospitalizations related to acute submission particularly. Despite the potential observed improvement in health service usage, the studies reporting survival and death numbers did not indicate any signi cant improvement [29,34,35,37,43] (see supplementary material 2). Insert Table 7 Quality of Life Signi cant improvements in quality of life of RMS groups were noted in six out of 11 studies, on different quality-of-life scales [32,33,35,39,42,43].…”

“…These were included as we are concerned with the existing interventions of the telemonitoring system that involve elderly patients at risk. All but one study, the GERONTACCESS study [37], which focused on nursing home settings, involved home-based remote monitoring. This was included as we are interested in understanding the French approach to remote monitoring for elderly individuals at high risk.…”

“…The impact on health outcomes was particularly evident in a signi cant reductions in the number of hospitalizations were observed in seven out of the twelve studies that evaluated this outcome, whether rehospitalization, unplanned hospitalization or other type [27,34,[36][37][38][39]41], De Batlle et al [39] (sample size IG: 48) and Tchalla et al, [38] (sample size IG: 276) reporting relative risk reductions of 57% and 28% in unplanned hospitalizations, respectively, and a 33.2% reduction in emergency admissions in a cohort study [41] with a sample size of 521 (Table 5). In terms of ED visits and LOS (Table 6), three studies reported signi cant reductions in ED visits [33,36,41] reaching 32% of relative risk reduction in Orozco-beltran et al [41], contrary to Tchalla et al [38], showing a signi cant increase in ED visits.…”

“…Three studies reported signi cant results with savings ranging between approximately €1000 and €2800 per person, including the cost of the telemonitoring system [32,36,39]. The other studies also favored RMS as a cost-effective solution, although these results were not statistically signi cant [37,42,43].…”

Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study (Preprint)

“…Telemedicine is a safe modality of care and is noninferior in geriatric patients presenting acute medical conditions in cases where they are accompanied on-site by a nursing caregiver [9]. Several studies evaluating geriatric telemedicine have shown a reduced number of emergency department visits and HAs from NHs [10][11][12][13][14][15][16][17][18][19][20][21][22]. Despite these positive effects on the overall level of care and the widespread accessibility of telemedical tools, deployment in primary care and NHs is only progressing slowly.…”