Standards for the Use of Telemedicine for Evaluation and Management of Resident Change of Condition in the Nursing Home

Gillespie, Suzanne M.; Moser, Andrea; Gokula, Murthy; Edmondson, Thomas; Rees, Joseph M.; Nelson, Dallas; Handler, Steven M.

doi:10.1016/j.jamda.2018.11.022

Cited by 42 publications

(55 citation statements)

References 13 publications

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“…This evaluation used CDS alerts and telemedicine so this technology may not reflect the usual technology available at other NHs and hence reduces generalizability of our results. However, NHs are increasing their use of telemedicine and CDS systems for other purposes 43 . Moreover, the CDS system used for this study is EHR‐agnostic supporting generalizability.…”

Section: Limitationsmentioning

confidence: 84%

Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events

Kane‐Gill

Wong

Culley

et al. 2020

J American Geriatrics Society

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Background/Objectives Federally‐mandated consultant pharmacist‐conducted retrospective medication regimen reviews (MRRs) are designed to improve medication safety in nursing homes (NH). However, MRRs are potentially ineffective. A new model of care that improves access to and efficiency of consultant pharmacists is needed. The objective of this study was to determine the impact of pharmacist‐led telemedicine services on reducing high‐risk medication adverse drug events (ADEs) for NH residents using medication reconciliation and prospective MRR on admission plus ongoing clinical decision support alerts throughout the residents’ stay. Design Quality improvement study using a stepped‐wedge design comparing the novel service to usual care in a one‐year evaluation from November 2016 to October 2017. Setting Four NHs (two urban, two suburban) in Southwestern Pennsylvania. Participants All residents in the four NHs were screened. There were 2,127 residents admitted having 652 alerts in the active period. Intervention Upon admission, pharmacists conducted medication reconciliation and prospective MRR for residents and also used telemedicine for communication with cognitively‐intact residents. Post‐admission, pharmacists received clinical decision support alerts to conduct targeted concurrent MRRs and telemedicine. Measurement Main outcome was incidence of high‐risk medication, alert‐specific ADEs. Secondary outcomes included all‐cause hospitalization, 30‐day readmission rates, and consultant pharmacists' recommendations. Results Consultant pharmacists provided 769 recommendations. The intervention group had a 92% lower incidence of alert‐specific ADEs than usual care (9 vs 31; 0.14 vs 0.61/1,000‐resident‐days; adjusted incident rate ratio (AIRR) = 0.08 (95% confidence interval (CI) = 0.01–0.40]; P = .002). All‐cause hospitalization was similar between groups (149 vs 138; 2.33 vs 2.70/1,000‐resident‐days; AIRR = 1.06 (95% CI = 0.72–1.58); P = .75), as were 30‐day readmissions (110 vs 102; 1.72 vs 2.00/1,000‐resident‐days; AIRR = 1.21 (95% CI = 0.76–1.93); P = .42). Conclusions This is the first evaluation of the impact of pharmacist‐led patient‐centered telemedicine services to manage high‐risk medications during transitional care and throughout the resident's NH stay, supporting a new model of patient care.

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Section: Limitationsmentioning

confidence: 84%

Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events

Kane‐Gill

Wong

Culley

et al. 2020

J American Geriatrics Society

Self Cite

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“…In early 2019, AMDA's Workgroup on Telemedicine and Technology published a white paper offering guidance to clinicians and facilities on the use of telemedicine to deliver medically necessary evaluation and management of change of condition for nursing home residents. 3 The paper reviewed the many research studies and published case reports that demonstrate the ability of telemedicine interventions to reduce avoidable emergency department visits and hospitalizations. In this issue of JAMDA , the GeriCare@North example also demonstrates the feasibility of deploying acute geriatric medicine consultation via telemedicine for a variety of routine and symptom-based concerns to nursing home residents in Singapore.…”

Section: The Case For Telemedicinementioning

confidence: 99%

Innovation Through Regulation: COVID-19 and the Evolving Utility of Telemedicine

Gillespie

Handler

Bardakh

2020

Journal of the American Medical Directors Association

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“…54 Also, in skilled nursing facilities (SNF), where a large number of surgical older patients are discharged to rehabilitation, 55 telemonitoring has been used to provide remote specialized care and reduce readmissions. 56,57 An advantage is that usability issues are less of a problem, as patients are assisted by trained staff of SNFs. 57…”

Section: Benefits and Barriers Of Ehealth Interventions Among Older Patientsmentioning

confidence: 99%

“…56,57 An advantage is that usability issues are less of a problem, as patients are assisted by trained staff of SNFs. 57…”

Section: Benefits and Barriers Of Ehealth Interventions Among Older Patientsmentioning

confidence: 99%

Feasibility of Perioperative eHealth Interventions for Older Surgical Patients: A Systematic Review

Jonker

Haveman

Bock³

et al. 2020

Journal of the American Medical Directors Association

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Objectives: EHealth interventions are increasingly being applied in perioperative care but have not been adequately studied for older surgical patients who could potentially benefit from them. Therefore, we evaluated the feasibility of perioperative eHealth interventions for this population. Design: A systematic review of prospective observational and interventional studies was conducted. Three electronic databases (PubMed, EMBASE, CINAHL) were searched between January 1999 and July 2019. Study quality was assessed by Methodological Index for Non-Randomized Studies (MINORS) with and without control group. Setting and Participants: Studies of surgical patients with an average age !65 years undergoing any perioperative eHealth intervention with active patient participation (with the exception of telerehabilitation following orthopedic surgery) were included. Measures: The main outcome measure was feasibility, defined as a patient's perceptions of usability, satisfaction, and/or acceptability of the intervention. Other outcomes included compliance and study completion rate. Results: Screening of 1569 titles and abstracts yielded 7 single-center prospective studies with 223 patients (range n ¼ 9e69 per study, average age 66e74 years) undergoing oncological, cardiovascular, or orthopedic surgery. The median MINORS scores were 13.5 of 16 for 6 studies without control group, and 14 of 24 for 1 study with a control group. Telemonitoring interventions were rated as "easy to use" by 89% to 95% of participants in 3 studies. Patients in 3 studies were satisfied with the eHealth intervention and would recommend it to others. Acceptability (derived from consent rate) ranged from 71% to 89%, compliance from 53% to 86%, and completion of study follow-up from 54% to 95%. Conclusions and Implications: Results of 7 studies involving perioperative eHealth interventions suggest their feasibility and encourage further development of technologies for older surgical patients. Future feasibility studies require clear definitions of appropriate feasibility outcome measures and a comprehensive description of patient characteristics such as functional performance, level of education, and socioeconomic status.

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Standards for the Use of Telemedicine for Evaluation and Management of Resident Change of Condition in the Nursing Home

Cited by 42 publications

References 13 publications

Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events

Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events

Innovation Through Regulation: COVID-19 and the Evolving Utility of Telemedicine

Feasibility of Perioperative eHealth Interventions for Older Surgical Patients: A Systematic Review

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