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Study Of Telemedicine Consultation at Home For Older Adults

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ClinicalTrials.gov Identifier: NCT01324687
Recruitment Status : Completed
First Posted : March 29, 2011
Results First Posted : March 21, 2016
Last Update Posted : June 9, 2017
Sponsor:
Collaborator:
Information provided by (Responsible Party):

Study Description
Brief 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.

Condition or disease Intervention/treatment
Physical Disorders Telemedicine Other: Telemedicine care

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.

Study Design

Study Type : Observational
Actual Enrollment : 1537 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Study Of Telemedicine Consultation at Home For Older Adults
Study Start Date : October 2010
Primary Completion Date : December 2015
Study Completion Date : December 2015
Groups and Cohorts

Group/Cohort Intervention/treatment
Control
Group without access to telemedicine in the home for acute care issues.
Telemedicine care
Cohort with access to telemedicine in the home for acute care issues.
Other: Telemedicine care
Availability of telemedicine
Other Name: Telemedicine


Outcome Measures

Primary Outcome Measures :
  1. Emergency Department Use [ Time Frame: Up to 42 months ]
    Use of emergency department by individuals with access to care via telemedicine as compared to those without such access to care.


Secondary Outcome Measures :
  1. Cost of Care [ Time Frame: Up to 36 months ]
    Comparison of cost of care between intervention and control groups.


Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01324687


Locations
United States, New York
University of Rochester
Rochester, New York, United States, 14642
Sponsors and Collaborators
University of Rochester
Agency for Healthcare Research and Quality (AHRQ)
Investigators
Principal Investigator: Manish N. Shah, MD University of Rochester
Principal Investigator: Kenneth McConnochie, MD University of Rochester
More Information

Responsible Party: Manish Shah, Associate Professor, University of Rochester
ClinicalTrials.gov Identifier: NCT01324687     History of Changes
Other Study ID Numbers: 31563
R01HS018047 ( U.S. AHRQ Grant/Contract )
First Posted: March 29, 2011    Key Record Dates
Results First Posted: March 21, 2016
Last Update Posted: June 9, 2017
Last Verified: April 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Manish Shah, University of Rochester:
Telemedicine
Geriatrics