Reliability of online geriatric consultation triage decisions: A pilot study

Dakin, Lucy; Cutler, Alison; Wright, Olivia; Martin‐Khan, Melinda; Varghese, Paul; Gray, Leonard C.

doi:10.1111/j.1741-6612.2011.00576.x

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…Previous research has shown that using videoconferencing for cognitive assessments is equally effective in detecting cognitive impairment and dementia as a conventional model. 2,3,5,6,7,8 The present study adds to that research in determining where videoconferencing is a more efficient alternative to conventional care when certain distances for travel are reached. The analysis indicates that videoconferencing would be a more efficient alternative to faceto-face clinics if the specialist's total (round trip) travelling time by car is more than about two hours.…”

Section: Discussionmentioning

confidence: 78%

A break-even analysis of delivering a memory clinic by videoconferencing

et al. 2013

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We analysed the costs of two kinds of dementia clinic. In the conventional clinic, held in a rural area, the specialist travels to the clinic from the city. In the videoconferencing clinic, patients are also seen in a rural area, but the specialist conducts the assessment by video from the city. The fixed costs common to both modalities, such as clinic infrastructure, were ignored. The total fixed cost of a monthly conventional clinic was $522 and the total fixed cost of a monthly videoconferencing clinic was $881. The additional variable cost of the specialist travelling to the conventional clinic was $2.62 per minute of the specialist's travelling time. The break-even point at which the cost of the two modalities is the same was just over two hours (138 min round trip). A sensitivity analysis showed that the break-even point was not particularly sensitive to changes in staff wages, but slightly more sensitive to the non labour costs of videoconferencing. Air travel is not an efficient alternative to travel by car. Reducing the number of clinics to six per year results in a much higher cost of running the videoconferencing service compared to the conventional service. Videoconferencing for the purpose of diagnosing dementia is both a reliable and cost effective method of health service provision when a specialist is required to drive for more than about two hours (round trip) to provide a memory disorder clinic service.

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Section: Discussionmentioning

confidence: 78%

A break-even analysis of delivering a memory clinic by videoconferencing

et al. 2013

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“…Rather, the justification for this service is based on two propositions. First, many studies have demonstrated the efficacy of inpatient comprehensive geriatric assessment services in improving a variety of clinical outcomes, including rate of functional recovery, discharge rates to long‐term care, and mortality . Second, available research suggests that aspects of the geriatric assessment process can be successfully conducted using telehealth strategies .…”

Section: Discussionmentioning

confidence: 99%

Telemedicine for Specialist Geriatric Care in Small Rural Hospitals: Preliminary Data

Gray

Fatehi

Martin‐Khan

et al. 2016

J American Geriatrics Society

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Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician-supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in-person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high-definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web-based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start-up and continued uninterrupted for the remainder of the 24-month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals.

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“…The application of telemedicine in geriatrics is relatively new, and sound evidence of benefits and cost-effectiveness is still lacking. 7 Although no evidence is available for this particular service model in terms of patient outcomes, a pilot in a similar setting showed promising results; 8 however, assessing telemedicine applications and their required resources is a challenge. 9 A review of economic analyses of real-time video communication states that telemedicine can be cost-effective for rural health care, depending upon the specific setting and health service delivery model.…”

Section: Introductionmentioning

confidence: 99%