Study Of Telemedicine Consultation at Home For Older Adults

This study is enrolling participants by invitation only.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Manish Shah, University of Rochester
ClinicalTrials.gov Identifier:
NCT01324687
First received: November 19, 2010
Last updated: November 4, 2013
Last verified: November 2013
  Purpose

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.

Condition Intervention
Physical Disorders
Telemedicine
Other: Telemedicine care

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: Study Of Telemedicine Consultation at Home For Older Adults

Further study details as provided by University of Rochester:

Primary Outcome Measures:
  • Emergency department use [ Time Frame: Up to 33 months ] [ Designated as safety issue: No ]
    Use of emergency department by individuals with access to care via telemedicine as compared to those without such access to care.


Secondary Outcome Measures:
  • Quality of acute illness communication to emergency departments [ Time Frame: Upon ED visit during 33 months of follow up ] [ Designated as safety issue: Yes ]
    Chart review of communication from primary care to ED based on a developed data sheet examining a number of metrics

  • Adherence to advanced directives [ Time Frame: Up to 33 months ] [ Designated as safety issue: No ]
    Adherence to advanced directives.

  • Satisfaction of patients, providers, and family experiencing telemedicine [ Time Frame: Up to 33 months ] [ Designated as safety issue: No ]
    Response to satisfaction survey regarding experience with telemedicine

  • Cost of care [ Time Frame: Up to 33 months ] [ Designated as safety issue: No ]
    Comparison of cost of care between intervention and control groups.


Estimated Enrollment: 600
Study Start Date: October 2010
Estimated Study Completion Date: June 2014
Primary Completion Date: November 2013 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Control
Group without access to telemedicine in the home for acute care issues.
Telemedicine
Cohort with access to telemedicine in the home for acute care issues.
Other: Telemedicine care
Availability of telemedicine
Other Name: Telemedicine

Detailed 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.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Adults residing in senior living communities.

Criteria

Inclusion Criteria:

  • Member of the Strong Health Geriatrics Group practice
  • Consent to participate
  • Resident of facility with telemedicine established

Exclusion Criteria:

- None

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01324687

Locations
United States, New York
University of Rochester
Rochester, New York, United States, 14642
Sponsors and Collaborators
University of Rochester
Investigators
Principal Investigator: Manish N. Shah, MD University of Rochester
Principal Investigator: Kenneth McConnochie, MD University of Rochester
  More Information

No publications provided

Responsible Party: Manish Shah, Associate Professor, University of Rochester
ClinicalTrials.gov Identifier: NCT01324687     History of Changes
Other Study ID Numbers: 31563, R01HS018047
Study First Received: November 19, 2010
Last Updated: November 4, 2013
Health Authority: United States: Institutional Review Board
United States: Federal Government

Keywords provided by University of Rochester:
Telemedicine
Geriatrics

ClinicalTrials.gov processed this record on September 15, 2014