Reducing Emergency Department Transfers from Skilled Nursing Facilities Through an Emergency Physician Telemedicine Service

Joseph, Joshua W.; Kennedy, Maura; Nathanson, Larry; Wardlow, Liane; Crowley, Catherine; Stuck, Amy

doi:10.5811/westjem.2020.7.46295

Cited by 25 publications

(54 citation statements)

References 27 publications

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“…2 Several studies suggested that integrating telehealth in care management for patients with chronic diseases can be effective in reducing hospitalizations and emergency department (ED) visits. [3][4][5][6][7] Other studies showed that, for elderly adults with multiple comorbidities, the use of ambulatory telehealth interventions (e.g., telemonitoring, video consults, and tele-exercise programs) can help improve access to specialists while achieving comparable health outcomes. 8,9 The nursing home is an area where telehealth technologies may help provide timely services to residents who lack access to onsite physicians, thus reducing costly and inconvenient transfers to EDs and hospitals.…”

Section: Introductionmentioning

confidence: 99%

Effects of a nursing home telehealth program on spending and utilization for Medicare residents

Hossain

Gilman

et al. 2022

Health Services Research

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Objective To assess the effects of eLongTermCare (eLTC), a telehealth program implemented by an integrated health system in 45 nursing homes across the Midwest, on the use of acute hospital services and total expenditures for Medicare residents. Data Sources Minimum Data Set, Medicare fee‐for‐service claims, and enrollment data from 2013 to 2018. Study Design We used a longitudinal difference‐in‐differences design to estimate the changes in outcomes for treatment beneficiaries before and after participating in the eLTC program, relative to changes for the matched comparison beneficiaries over the same period. We measured outcomes over a 24‐month follow‐up period, including total Medicare spending, emergency department (ED) visits, hospitalizations, and the likelihood of readmission. Data Collection/Extraction Methods Using administrative data, we identified treatment beneficiaries who stayed at participating nursing facilities during the program period and matched comparison beneficiaries with similar baseline characteristics from non‐participating facilities in the same geographic locations. Principal Findings For long‐term care residents, the eLTC program led to an estimated reduction of 73 ED visits per 1000 beneficiaries (p < 0.01, 8.6% effect) over the two‐year follow‐up period. The estimated effects for this group were concentrated among beneficiaries who entered the nursing home after program startup, with sizable reductions in hospitalizations, ED visits, and spending. For skilled care residents, the program was associated with an estimated reduction of 85 ED visits per 1000 beneficiaries (p = 0.03, 9.7% effect), but had no discernible effect on their hospitalizations or total Medicare spending. Conclusions Telehealth can be a valuable tool for nursing homes to enhance care coordination and provide timely access to care, leading to lower spending for nursing home residents. Future research needs to explore payment methods that encourage telehealth expansion in nursing homes.

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Section: Introductionmentioning

confidence: 99%

Effects of a nursing home telehealth program on spending and utilization for Medicare residents

Hossain

Gilman

et al. 2022

Health Services Research

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“…Barriers to quality improvement Significant barriers identified in literature review preventing successful integration of quality improvement initiatives include the following: (1) the presentation of HF can be nonspecific and make it difficult to diagnose; (2) guidelinedirected drugs are underused owing to doubt on their utility and safety concerns; (3) SNF providers can be uncomfortable managing HF owing to complexity and autonomy at end-oflife decisions; (4) there is mistrust and lack of timely communication between SNF staff, patients, and their families; (5) there are limited resources in terms of diagnostic studies and access to specialists for care of patients; and (6) there are poor information sharing and transfer capabilities. 2,6,8,9 Figure 6 Hospital readmission rates before and after VPExam QI intervention. Hospital readmission data have an average monthly 30-day readmission rate of 15.91% for the year leading up to VPExam QI.…”

Section: Discussionmentioning

confidence: 99%

“…Transfer of SNF residents to emergency departments is linked to increased morbidity and mortality, as well as significant cost. 8 The average cost of readmission is $15,200 across various payers. Moderate-significance VPExam clinical modification is associated with a significant reduction in 30-day hospitalizations.…”

Section: Vpexam Virtual Care Financial Analysis and Feasibilitymentioning

confidence: 99%

VPExam Virtual Care for Heart Failure Optimizing Transitions of Care Quality Improvement Project (VPExam QI)

Shah

Annam

Cireddu³

et al. 2022

Cardiovascular Digital Health Journal

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“…Study results indicate that implementation of telehealth interventions is an effective way to deliver health services to rural communities, with positive influences on the quality, coordination, and organisation of health care services [ 7 ], bringing a reduction in unnecessary emergency admissions and hospitalizations rates [ 8 – 10 ]. Furthermore, earlier studies report on financial savings, reduced physical restraints, and improved vital signs related to telehealth in nursing homes [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges in current nursing home care in rural Germany and how they can be reduced by telehealth - an exploratory qualitative pre-post study

May

Jonas

Fehler

et al. 2021

BMC Health Serv Res

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Background Telemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. The goal was to assess the effect of implementing medical video consultations into nursing home care addressing the following research questions: How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? How can video consultations be used to reduce difficulties arising in everyday care? How does implementation of video consultations impact day-to-day nursing home care delivery? Methods Twenty-one guided interviews (pre-implementation n = 13; post-implementation n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis. Results Challenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly. Conclusions Telehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.

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Reducing Emergency Department Transfers from Skilled Nursing Facilities Through an Emergency Physician Telemedicine Service

Cited by 25 publications

References 27 publications

Effects of a nursing home telehealth program on spending and utilization for Medicare residents

Effects of a nursing home telehealth program on spending and utilization for Medicare residents

VPExam Virtual Care for Heart Failure Optimizing Transitions of Care Quality Improvement Project (VPExam QI)

Challenges in current nursing home care in rural Germany and how they can be reduced by telehealth - an exploratory qualitative pre-post study

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