Study Of Telemedicine Consultation at Home For Older Adults

Telemedicine Clinical Trial

Official title:

Study Of Telemedicine Consultation at Home For Older Adults

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01324687
• Other study ID #: 31563
• Secondary ID: R01HS018047
• Status: Active, not recruiting
• Phase: N/A
• First received: November 19, 2010
• Last updated: December 21, 2015
• Start date: October 2010
• Est. completion date: December 2015

Study information

• Verified date: December 2015
• Source: University of Rochester
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review BoardUnited States: Federal Government
• Study type: Observational

Clinical Trial Summary

The system of medical care for older adults with acute illnesses often serves them poorly. Many factors limit these patients' access to safe, patient-centered, efficient, high-quality, acute care. These factors include a shortage of geriatricians and primary care physicians; limited availability of timely, acute-illness, patient appointments; emergency department (ED) crowding; interruptions to the continuity of care when patients use the ED; and poor transitions of care from the ambulatory setting to the ED. These conditions foster unnecessary ED use, adverse events in the ED for which older adults are particularly at-risk, and unnecessary medical costs. As the population ages, the magnitude of these problems will only increase.

The overarching study goals are to develop and evaluate a telemedicine-enhanced care model that improves access to safe, high-quality, acute illness care for older adults; fosters appropriate use of health services; and reduces unnecessary expenditures. Specifically, this study aims to:

1. Expand the existing pediatric HeA telemedicine network to older adults by providing senior living communities (SLC) with an alternative on-site care option for individuals with an acute illness episode.

Hypothesis 1: 90% of requested telemedicine visits will be successfully completed.

2. Evaluate the impact of the HeA telemedicine model on utilization, quality of care, and patient safety.

Hypothesis 2: The rate of ED use will be lower at SLCs with access to care via telemedicine, as compared to SLCs without such access to care.

Hypothesis 3: Quality of care and patient safety measures will be better for SLC residents with access to telemedicine-enhanced care than for residents without this form of access.

3. Evaluate the economic benefit of the care delivered through the telemedicine network.

Hypothesis 4: The net cost of healthcare per patient-month will be less for SLC residents with access to telemedicine-enhanced care than for those without this form of access.

4. Use qualitative methods to identify strategies and assets that promote and conditions that impede the implementation, acceptance, and success of the HeA telemedicine network in SLCs. This knowledge will inform efforts to develop a toolkit to be used to disseminate this technology broadly.

Description:

Telemedicine is a potential solution with demonstrated effectiveness in other vulnerable populations. Previous work by members of this research team has shown that telemedicine is an effective health information technology solution to address similar challenges in multiple vulnerable populations, demonstrating both improved access to care and reduced ED visits. The existing telemedicine program in Rochester, Health-e-Access (HeA), has been both successful and sustained, and well accepted by all key stakeholders including patients, families, clinicians, and insurers. This existing program, combined with the experience and multidisciplinary expertise of the investigators research team, creates a unique opportunity to (1) develop a model of care that leverages this technology to improve geriatric acute care, (2) evaluate this model through a prospective cohort study, and (3) identify key barriers and drivers of implementation to promote dissemination.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 600
• Est. completion date: December 2015
• Est. primary completion date: June 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Member of the Strong Health Geriatrics Group practice

• Consent to participate

• Resident of facility with telemedicine established

Exclusion Criteria:

• None

Study Design

Observational Model: Cohort, Time Perspective: Prospective

Related Conditions & MeSH terms

• Physical Disorders
• Telemedicine

Intervention

Other:
• Telemedicine care
Availability of telemedicine

Locations

Country	Name	City	State
United States	University of Rochester	Rochester	New York

Sponsors (2)

Lead Sponsor	Collaborator
University of Rochester	Agency for Healthcare Research and Quality (AHRQ)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Emergency department use	Use of emergency department by individuals with access to care via telemedicine as compared to those without such access to care.	Up to 33 months	No
Secondary	Quality of acute illness communication to emergency departments	Chart review of communication from primary care to ED based on a developed data sheet examining a number of metrics	Upon ED visit during 33 months of follow up	Yes
Secondary	Adherence to advanced directives	Adherence to advanced directives.	Up to 33 months	No
Secondary	Satisfaction of patients, providers, and family experiencing telemedicine	Response to satisfaction survey regarding experience with telemedicine	Up to 33 months	No
Secondary	Cost of care	Comparison of cost of care between intervention and control groups.	Up to 33 months	No