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Cai S, Qin Q, Veazie P, Temkin-Greener H. Telemedicine and Disparities in Mental Health Service Use Among Community-Dwelling Older Adults With Alzheimer Disease and Related Dementias. J Am Med Dir Assoc 2024; 25:105027. [PMID: 38768645 DOI: 10.1016/j.jamda.2024.105027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To examine disparities in mental health (MH) service utilization, via in-person and telemedicine (ie, tele-MH), by individuals' race, ethnicity, and community socioeconomic status, among community-dwelling older adults with Alzheimer disease and related dementias (ADRD) before and after the expansion of the Centers for Medicare and Medicaid Services' (CMS's) telemedicine policy. DESIGN Observational study. SETTING AND PARTICIPANTS A total of 3,003,571 community-dwelling Medicare beneficiaries with ADRD between 2019 and 2021 were included in the study. METHODS Multiple national data were linked. The unit of analysis was individual-quarter. Three outcomes were defined: any MH visits (in-person or tele-MH), in-person MH visits, and tele-MH visits per quarter. Key independent variables included individual race and ethnicity, the socioeconomic status of the community, and an indicator for the implementation of the telemedicine policy. Regression analyses with individual random effects were used. RESULTS In general, Black and Hispanic older adults with ADRD and those in socioeconomically deprived communities were less likely to have MH visits than white adults and those from less-deprived communities. In-person and tele-MH visits varied throughout the pandemic and across subpopulations. For instance, at the beginning of the pandemic, white, Black, and Hispanic older adults experienced 5.05, 3.03, and 2.87 percentage point reductions in in-person MH visits, and 3.53, 1.26, and 0.32 percentage point increases in tele-MH visits (with P < .01 for racial/ethnic differences), respectively. During the pandemic, the increasing trend in in-person MH visits and the decreasing trend in tele-MH visits varied across different subgroups. Overall, racial and ethnic differences in any MH visits were reduced, but the gap in any MH visits between deprived and less-deprived communities doubled during the pandemic (P < .01). CONCLUSIONS AND IMPLICATIONS Telemedicine may have provided an opportunity to improve access to MH services among underserved populations. However, although some disparities in MH care were reduced, others widened, underscoring the importance of equitable health care access strategies to address the unique needs of different populations.
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Affiliation(s)
- Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Chary A, Hernandez N, Rivera AP, Ramont V, Obi T, Santangelo I, Ritchie C, Singh H, Hayden E, Naik AD, Liu S, Kennedy M. Perceptions of Acute Care Telemedicine Among Caregivers for Persons Living with Dementia: A Qualitative Study. J Appl Gerontol 2024; 43:69-77. [PMID: 37682526 PMCID: PMC10693729 DOI: 10.1177/07334648231198018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Persons living with dementia (PLWD) have high emergency department (ED) utilization. Little is known about using telemedicine with PLWD and caregivers as an alternative to ED visits for minor acute health problems. This qualitative interview-based study elicited caregivers' perspectives about the acceptability of telemedicine for acute complaints. We performed telephone interviews with 28 caregivers of PLWD from two academic EDs, one in the Northeast and another in the South. Using a combined deductive-inductive approach, we coded interview transcripts and elucidated common themes by consensus. All caregivers reported they would need to participate in the telemedicine visit to help overcome communication and digital literacy challenges. People from racial/ethnic minority groups reported lower comfort with the virtual format. In both sites, participants expressed uncertainty about illness severity that could preclude using telemedicine for acute complaints. Overall, respondents deemed acute care telemedicine acceptable, but caregivers describe specific roles as crucial intermediaries to facilitate virtual care.
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Affiliation(s)
- Anita Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Norvin Hernandez
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Vivian Ramont
- University of Texas School of Public Health, UT Health Science Center, Houston, TX, USA
| | - Tracey Obi
- University of Texas School of Public Health, UT Health Science Center, Houston, TX, USA
| | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Hardeep Singh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Emily Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aanand D. Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- University of Texas School of Public Health, UT Health Science Center, Houston, TX, USA
- Consortium on Aging, University of Texas Health Science Center, Houston, TX, USA
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Wardlow L, Roberts C, Archbald-Pannone L. Perceptions and Uses of Telehealth in the Care of Older Adults. Telemed J E Health 2023; 29:1143-1151. [PMID: 36493377 PMCID: PMC10440646 DOI: 10.1089/tmj.2022.0378] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Clinicians identify challenges in using telehealth with older adults, yet they continue to use it at high rates. We conducted a nation-wide survey of US clinicians to assess the views and uses of telehealth for older adults (≥65 years old); as well as the perceived advantages and challenges of telehealth and use of age-friendly telehealth practices. Materials/Methods: We distributed an online survey (Wallin Opinion Research) to assess the use of telehealth and clinicians' views on advantages/challenges of telehealth in care of older adults. Respondents were eligible if they were active US clinicians with self-attestation of patient population ≥10% older adults. The survey was distributed through established professional networks. Eligible respondents received a gift card for participation, fulfilled by a third-party vendor. Survey participation was voluntary. Completion of the survey was considered consent to participate. The study was reviewed and determined exempt by the WCG's IRB Affairs Department. SPSS Version-26 was used for descriptive statistics. Results: Approximately 13,300 surveys were distributed and there were 7,246 (55%) respondents. Over half (56%) respondents were licensed independent practitioners. The majority of respondents practiced geriatric medicine (22%) or primary care (9.7%). The most common use was in hospitals (53%), long-term care facilities (47%), and outpatient (47%) settings. The majority of respondents (55%) selected "telehealth improves healthcare for older adults by enhancing engagement between stakeholders" as a top advantage. Fewer primary care clinicians (47%) reported sufficient support in the use of telehealth, as compared with clinicians in geriatrics (62%) or other specialties (60%). A majority (65%) of respondents reported use one or more age-friendly practice (40% often; 25% always). Only 5% of respondents reported that their telehealth program never utilized age-friendly practices. Discussion and Conclusion: Clinicians use telehealth in care of older adults, across clinical roles, sites, and purposes. Our survey results suggest perceived advantages of telehealth outweigh challenges, in care of older adults. This highlights an opportunity for guidance and resources to optimizing telehealth with older adults.
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Affiliation(s)
- Liane Wardlow
- Clinical Research and Telehealth, West Health Institute, La Jolla, California, USA
| | - Carly Roberts
- Clinical Research and Telehealth, West Health Institute, La Jolla, California, USA
| | - Laurie Archbald-Pannone
- Division of General, Geriatric, Hospital and Palliative Medicine, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Glober N, LaShell A, Montelauro N, Troyer L, Supples M, Unroe K, Tainter C, Faris G, Fuchita M, Boustani M. Impact of interhospital transfer on patients with Alzheimer's disease and other related dementias. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12469. [PMID: 37693225 PMCID: PMC10485388 DOI: 10.1002/dad2.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Older adults are often transferred from one emergency department (ED) to another hospital for speciality care, but little is known about whether those transfers positively impact patients, particularly those with Alzheimer's disease and other related dementias (ADRD). In this study we aimed to describe the impact of interhospital transfer on older adults with and without ADRD. In a retrospective review of electronic medical records, we collected data on demographics, insurance type, initial code status, intensive care, length of stay, specialist consult, procedure within 48 hours, and discharge disposition for older adults (≥ 65 years). We included older adults with at least one ED visit, who were transferred to a tertiary care hospital. With logistic regression, we estimated odds of death, intensive care stay, or procedure within 48 hours by ADRD diagnosis. Patients with ADRD more often received a geriatrics (p < 0.001) or palliative care consult (p = 0.038). They were less likely to be full code at admission (p < 0.001) or to be discharged home (p < 0.001). Patients living with ADRD less often received intensive care or a procedure within 48 hours of transfer (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.22-2.88). Patients with ADRD were less likely to receive intensive care unit admission or specialist procedures after transfer. Further study is indicated to comprehensively understand patient-centered outcomes.
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Affiliation(s)
- Nancy Glober
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | | | - Lindsay Troyer
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - Michael Supples
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kathleen Unroe
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | - Greg Faris
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | - Malaz Boustani
- Indiana University School of MedicineIndianapolisIndianaUSA
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Wardlow L, Leff B, Biese K, Roberts C, Archbald-Pannone L, Ritchie C, DeCherrie LV, Sikka N, Gillespie SM. Development of telehealth principles and guidelines for older adults: A modified Delphi approach. J Am Geriatr Soc 2023; 71:371-382. [PMID: 36534900 DOI: 10.1111/jgs.18123] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic elevated telehealth as a prevalent care delivery modality for older adults. However, guidelines and best practices for the provision of healthcare via telehealth are lacking. Principles and guidelines are needed to ensure that telehealth is safe, effective, and equitable for older adults. The Collaborative for Telehealth and Aging (C4TA) composed of providers, experts in geriatrics, telehealth, and advocacy, developed principles and guidelines for delivering telehealth to older adults. Using a modified Delphi process, C4TA members identified three principles and 18 guidelines. First, care should be person-centered; telehealth programs should be designed to meet the needs and preferences of older adults by considering their goals, family and caregivers, linguistic characteristics, and readiness and ability to use technology. Second, care should be equitable and accessible; telehealth programs should address individual and systemic barriers to care for older adults by considering issues of equity and access. Third, care should be integrated and coordinated across systems and people; telehealth should limit fragmentation, improve data sharing, increase communication across stakeholders, and address both workforce and financial sustainability. C4TA members have diverse perspectives and expertise but a shared commitment to improving older adults' lives. C4TA's recommendations highlight older adults' needs and create a roadmap for providers and health systems to take actionable steps to reach them. The next steps include developing implementation strategies, documenting current telehealth practices with older adults, and creating a community to support the dissemination, implementation, and evaluation of the recommendations.
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Affiliation(s)
- Liane Wardlow
- Clinical Research, West Health Institute, La Jolla, CA, USA
| | - Bruce Leff
- The Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Biese
- Emergency and Geriatric Medicine, University of North Carolina Health, Chapel Hill, NC, USA
| | - Carly Roberts
- Clinical Research, West Health Institute, La Jolla, CA, USA
| | | | - Christine Ritchie
- Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard University, Boston, MA, USA
| | - Linda V DeCherrie
- Clinical Strategy and Implementation, Medically Home, New York, New York, USA
| | - Neal Sikka
- Emergency Medicine, The George Washington University, Washington, DC, USA
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How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer's Disease and Related Dementias? A Narrative Review. Medicina (B Aires) 2022; 58:medicina58121705. [PMID: 36556907 PMCID: PMC9783876 DOI: 10.3390/medicina58121705] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer's disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.
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Valk-Draad MP, Bohnet-Joschko S. Nursing Home-Sensitive Hospitalizations and the Relevance of Telemedicine: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12944. [PMID: 36232255 PMCID: PMC9566431 DOI: 10.3390/ijerph191912944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The aging of society is increasing the number of hospitalizations of nursing home residents. Telemedicine might help reduce the frequency of these potentially risk-associated hospitalizations. This scoping review looked for evidence of a change in the rate of hospitalization and, if mentioned, any cost savings and/or staff acceptance of the use of telemedicine in a nursing home setting. To identify available evidence, the electronic databases PubMed, Livivo, EBSCO and JSTOR were searched (without time or regional constraints) for comparative primary research studies on this topic in peer-reviewed journals. A total of 1127 articles were retrieved and 923 titles and abstracts were screened, with 16 studies published between 2001 and 2022 being included. Telemedicine consultation reduced the hospitalization of nursing home residents in 14/16 and care costs in 8/11 articles. Staff satisfaction was mentioned positively in five studies. Most studies used telemedicine involving medical diagnostic technologies (10), (electronic) health records (9), specialists (9) and specialized nursing staff (11). Few studies had a higher level of evidence: only one randomized clinical trial was included. There is the need for high credibility studies, using guidelines on protocol and reporting, to better understand the hindering and facilitating factors of telemedicine provision in the healthcare of nursing home residents.
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Affiliation(s)
- Maria Paula Valk-Draad
- Chair of Health Care Management and Innovation, Faculty of Management, Economics, and Society, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
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Hill JD, Schmucker AM, Siman N, Goldfeld KS, Cuthel AM, Chodosh J, Bouillon-Minois JB, Grudzen CR. Emergency and post-emergency care of older adults with Alzheimer's disease/Alzheimer's disease related dementias. J Am Geriatr Soc 2022; 70:2582-2591. [PMID: 35612546 PMCID: PMC9489611 DOI: 10.1111/jgs.17833] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The emergency department (ED) is a critical juncture in the care of persons living with dementia (PLwD), as they have a high rate of hospital admission, ED revisits, and subsequent inpatient stays. We examine ED disposition of PLwD compared with older adults with non-dementia chronic disease as well as healthcare utilization and survival. METHODS Medicare claims data were used to identify community-dwelling older adults 66+ years old from 34 hospitals with either Alzheimer's disease/Alzheimer's disease related dementias (AD/ADRD) or a non-AD/ADRD chronic condition between January 1, 2014, and December 31, 2018. We compared ED disposition at the index visit, as well as healthcare utilization and mortality in the 12 months following an index ED visit, and adjusted for age, gender, and risk of mortality. RESULTS There were 29,626 patients in the AD/ADRD sample, and 317,046 in the comparison sample. The AD/ADRD sample was older (82.4 years old [SD: 8.2] vs. 76.0 years old [SD: 7.7]) and had more female patients (59.9% vs. 54.7%). The AD/ADRD sample was more likely to experience ED disposition to acute care (OR 1.039, p < 0.001, 95% CI 1.029-1.050), to have an ED revisit (OR 1.077, p < 0.001, 95% CI 1.066-1.087), and an inpatient stay in the subsequent 12 months (OR 1.085, p < 0.001, 95% CI 1.075-1.095). ED disposition to hospice was low in both samples (0.2%). AD/ADRD patients had a higher risk of mortality (OR 1.099, p < 0.001, 95% CI 1.091-1.107) and high short-term mortality (31.9% within 12 months) than those without AD/ADRD (15.3% within 12 months). CONCLUSIONS PLwD who visit the ED have high short-term mortality. Despite this, disposition to acute care, ED revisits, and inpatient stays, rather than hospice, remain the predominant mode of care delivery. Transition directly from the ED to hospice for PLwD is rare.
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Affiliation(s)
- Jacob D. Hill
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Abigail M. Schmucker
- Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Keith S. Goldfeld
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Allison M. Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Joshua Chodosh
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, Division of Geriatrics and Palliative Care, NYU Langone Health, NY, USA
| | - Jean-Baptiste Bouillon-Minois
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
- CHU Clermont-Ferrand, Emergency Department, Clermont-Ferrand, F-63000, France
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Sadeh R, Shashar S, Shaer E, Slutsky T, Sagy I, Novack V, Zeldetz V. Modified Shock Index as a Predictor for Mortality and Hospitalization Among Patients With Dementia. J Emerg Med 2022; 62:590-599. [PMID: 35181187 DOI: 10.1016/j.jemermed.2021.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND One in four older adults in the Emergency Department (ED) suffers from severe cognitive impairment, creating great difficulty for the emergency physicians who determine the urgency of their patients' condition, which informs decisions regarding discharge or hospitalization. OBJECTIVE Our objective was to determine whether modified shock index (MSI) can be a clinical mortality and hospitalization predictor when applied to older patients with dementia in the ED. METHODS Included in the research were all patients with dementia, > 65 years old, who arrived at the Soroka University Medical Center ED during 2014-2017. The population was divided into three groups according to their MSI score, calculated as heart rate/mean arterial pressure: MSI < 0.7; 0.7 > MSI < 1.3; and MSI > 1.3. We performed multivariable logistic regression as a predictor of death within 30 days, Cox analysis for number of days to death, and a negative binominal regression for predicting the number of admission days. RESULTS Included were 1437 patients diagnosed with dementia. Patients with an MSI > 1.3 vs. those with MSI < 0.7 had an odds ratio of 8.23 (95% confidence interval [CI] 4.64-4.54) for mortality within 30 days, increased mortality risk within 180 days (hazard ratio 4.42; 95% CI 2.64-7.41), and longer hospitalization duration (incidence rate ratio 1.8; 95% CI 1.32-2.45). CONCLUSIONS High MSI scores were associated with high mortality rates and longer hospitalization duration for patients diagnosed with dementia who were > 65 years old. We suggest performing prospective studies utilizing the MSI score as an indicator in ED triage settings to classify patients with dementia by their severity of risk, to determine if this benefits health, minimizes expenses, and prevents unnecessary hospitalizations.
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Affiliation(s)
- Re'em Sadeh
- Joyce and Irwing Goldman Medical School, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Beer-Sheva, Israel
| | - Sagi Shashar
- Joyce and Irwing Goldman Medical School, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Beer-Sheva, Israel
| | - Ela Shaer
- Emergency Department, Soroka University Medical Center and the Faculty of Health Sciences, Beer-Sheva, Israel
| | - Tzachi Slutsky
- Emergency Department, Soroka University Medical Center and the Faculty of Health Sciences, Beer-Sheva, Israel
| | - Iftach Sagy
- Joyce and Irwing Goldman Medical School, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Beer-Sheva, Israel; Internal Medicine Division, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Victor Novack
- Joyce and Irwing Goldman Medical School, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Beer-Sheva, Israel; Internal Medicine Division, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vladimir Zeldetz
- Joyce and Irwing Goldman Medical School, Beer-Sheva, Israel; Emergency Department, Soroka University Medical Center and the Faculty of Health Sciences, Beer-Sheva, Israel
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Ford JH, Jolles SA, Heller D, Langenstroer M, Crnich C. There and back again: the shape of telemedicine in U.S. nursing homes following COVID-19. BMC Geriatr 2022; 22:337. [PMID: 35436869 PMCID: PMC9015887 DOI: 10.1186/s12877-022-03046-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Telemedicine use in nursing homes (NHs) expanded during the COVID-19 pandemic. The objectives of this study were to characterize plans to continue telemedicine among newly adopting NHs and identify factors limiting its use after COVID-19. Methods Key informants from 9 Wisconsin NHs that adopted telemedicine during COVID-19 were recruited. Semi-structured interviews and surveys were employed to identify participant perceptions about the value of telemedicine, implementation challenges encountered, and plans and barriers to sustaining its delivery after COVID-19. Directed content analysis and a deductive thematic approach using the Systems Engineering Initiative for Patient Safety (SEIPS) model was used during analyses. Quantitative and qualitative data were integrated to identify participant views on the value of telemedicine and the tools and work system enhancements needed to make telemedicine easier and more effective. Results All participating NHs indicated a preference to continue telemedicine after COVID-19. Urgent assessments of resident change-in-condition and cognitively based sub-specialty consultations were identified as the encounter types most amenable to telemedicine. Reductions in resident off-site encounters and minimization of resident therapy interruptions were identified as major benefits of telemedicine. Twelve work system enhancements needed to better sustain telemedicine were identified, including improvements to: 1) equipment/IT infrastructure; 2) scheduling; 3) information exchange; and 4) telemedicine facilitators. Discussion NHs that adopted telemedicine during COVID-19 wish to continue its use. However, interventions that enhance the integration of telemedicine into NH and off-site clinic work systems require changes to existing regulations and reimbursement models to sustain its utilization after COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03046-y.
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Affiliation(s)
- James H Ford
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, 777 Highland Ave, Madison, WI, 53705, USA.
| | - Sally A Jolles
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Dee Heller
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Christopher Crnich
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton VA Hospital, Madison, WI, USA
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Chang B, Yang Y, Buitrago Leon GA, Lu Y. Effect of Collaborative Governance on Medical and Nursing Service Combination: An Evaluation Based on Delphi and Entropy Method. Healthcare (Basel) 2021; 9:healthcare9111456. [PMID: 34828502 PMCID: PMC8622114 DOI: 10.3390/healthcare9111456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/04/2022] Open
Abstract
[Background]: Improvement of synergies in medical and nursing services can help governments to optimize the allocation of medical resources; however, an appropriate evaluation method is critical for a suitable decision process in this regard. [Method]: To assess the medical and nursing service combination (MNSC) at a regional level, this study applied a five-dimension evaluation index composed of 28 basic response areas related to the MNSC development status in China, determining its respective weight through the Delphi and entropy methods. [Result]: This empirical exercise analyzed the MNSC supply system by interviewing nine heads of medical and nursing institutions and eleven healthcare-related government personnel during August of 2020 in Xinxiang City, Henan province, P.R China. Results showed: (1) public satisfaction with the fees charged by Medical and Nursing service Institutions (MNSI); (2) Medicare and supply services’ policy publicity; (3) the external financing situation of MNSI; (4) the medical staff’s professional quality; (5) the medical facilities and supply of MNSI; and (6) that the recognition level of the development plan of MNSI scored the highest effect on the synergy of MNSC supply among the assessed factors. [Conclusion]: These results showed that an evaluation based on the Delphi and entropy methods can effectively integrate the opinions of experts and related institutions to evaluate synergies on the medical and nursing service supply.
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Affiliation(s)
- Beiquan Chang
- School of Public Policy and Management, Tsinghua University, Beijing 100084, China
- Correspondence: (B.C.); (Y.Y.)
| | - Yansui Yang
- School of Public Policy and Management, Tsinghua University, Beijing 100084, China
- Correspondence: (B.C.); (Y.Y.)
| | | | - Yuzhong Lu
- Glorious Sun School of Business, Donghua University, Shanghai 200051, China;
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12
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McNabney MK. How Should Assisted Living Be Using Emergency Departments? J Am Med Dir Assoc 2021; 22:899-900. [PMID: 33832713 DOI: 10.1016/j.jamda.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
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13
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Quail Z, Bolton L, Massey K. Digital delivery of non-pharmacological intervention programmes for people living with dementia during the COVID-19 pandemic. BMJ Case Rep 2021; 14:e242550. [PMID: 34140328 PMCID: PMC8212172 DOI: 10.1136/bcr-2021-242550] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 01/10/2023] Open
Abstract
The COVID-19 pandemic significantly impeded face-to-face health and social care delivery for people living with dementia and their carers. Interruption of meaningful activity engagement along with increased social isolation is known to be associated with loss of skills, increased loneliness, physical deterioration and decline in cognition and mood in people with dementia. To ensure continuity of care for people living with dementia, for whom multimodal, non-pharmacological intervention programmes were being provided, there was an urgent need to adopt a remote delivery model. Guidance on digitally delivered assessment and care specific to non-pharmacological interventions for dementia is lacking. Adoption of technology-enabled care for people with dementia requires overcoming barriers to technology use, adaptation of therapeutic guidelines, adaptation of communication methods and carer support. Despite these challenges, therapists successfully transitioned from in-person to digital delivery of therapeutic interventions with associated benefits of continued meaningful activity engagement discussed.
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Affiliation(s)
- Zara Quail
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
| | - Laura Bolton
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
| | - Karina Massey
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
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14
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Hua CL, Zhang W, Cornell PY, Rahman M, Dosa DM, Thomas KS. Characterizing Emergency Department Use in Assisted Living. J Am Med Dir Assoc 2021; 22:913-917.e2. [PMID: 32646819 PMCID: PMC7785650 DOI: 10.1016/j.jamda.2020.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Little is known about emergency department (ED) utilization among the nearly 1 million older adults residing in assisted living (AL) settings. Unlike federally regulated nursing homes, states create and enforce AL regulations with great variability, which may affect the quality of care provided. The objective of this study was to examine state variability in all-cause and injury-related ED use among residents in AL. DESIGN Observational retrospective cohort study. SETTING AND PARTICIPANTS We identified a cohort of 293,336 traditional Medicare beneficiaries residing in larger AL communities (25+ beds). METHODS With Medicare enrollment and claims data, we identified ED visits and classified those because of injury. We present rates of all-cause and injury-related ED use per 100 person-years in AL, by state, adjusting for age, sex, race, dual-eligibility, and chronic conditions. RESULTS Risk-adjusted state rates of all-cause ED visits ranged from 100.9 visits/100 AL person-years [95% confidence interval (CI) 92.8, 109.9] in New Mexico to 162.3 visits/100 AL person-years (95% CI 154.0, 174.7) in Rhode Island. The risk-adjusted rate of injury-related ED visits ranged from 18.7 visits/100 AL person-years (95% CI 17.2, 20.3) in New Mexico to 35.7 visits/100 AL person-years (95% CI 34.7, 36.8) in North Carolina. CONCLUSIONS AND IMPLICATIONS We observed significant variability among states in all-cause and injury-related ED use among AL residents. There is an urgent need to better understand why this variability is occurring to prevent avoidable visits to the ED.
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Affiliation(s)
- Cassandra L Hua
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Wenhan Zhang
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Portia Y Cornell
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Momotazur Rahman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - David M Dosa
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Kali S Thomas
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
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15
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Telehealth in Neurodegenerative Diseases: Opportunities and Challenges for Patients and Physicians. Brain Sci 2021; 11:brainsci11020237. [PMID: 33668641 PMCID: PMC7917616 DOI: 10.3390/brainsci11020237] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Telehealth, by definition, is distributing health-related services while using electronic technologies. This narrative Review describes the technological health services (telemedicine and telemonitoring) for delivering care in neurodegenerative diseases, Alzheimer's disease, Parkinson's Disease, and amyotrophic lateral Sclerosis, among others. This paper aims to illustrate this approach's primary experience and application, highlighting the strengths and weaknesses, with the goal of understanding which could be the most useful application for each one, in order to facilitate telehealth improvement and use in standard clinical practice. We also described the potential role of the COVID-19 pandemic to speed up this service's use, avoiding a sudden interruption of medical care.
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16
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Shaw JG, Sankineni S, Olaleye CA, Johnson KL, Locke JL, Patino J, Sabi FL, McCarthy RJ. A Novel Large Scale Integrated Telemonitoring Program for COVID-19. Telemed J E Health 2021; 27:1317-1321. [DOI: 10.1089/tmj.2020.0384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James G. Shaw
- Virtual Home Care Program, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Sandeep Sankineni
- Virtual Home Care Program, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Charles A. Olaleye
- Virtual Home Care Program, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Kari L. Johnson
- Virtual Home Care Program, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Jessica L. Locke
- Regional Offices, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - John Patino
- Operational Analytics, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Farzaneh L. Sabi
- Virtual Home Care Program, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
- Regional Offices, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Richard J. McCarthy
- Regional Offices, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
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17
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Joseph JW, Kennedy M, Nathanson LA, Wardlow L, Crowley C, Stuck A. Reducing Emergency Department Transfers from Skilled Nursing Facilities Through an Emergency Physician Telemedicine Service. West J Emerg Med 2020; 21:205-209. [PMID: 33207167 PMCID: PMC7673904 DOI: 10.5811/westjem.2020.7.46295] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/11/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Transfers of skilled nursing facility (SNF) residents to emergency departments (ED) are linked to morbidity, mortality and significant cost, especially when transfers result in hospital admissions. This study investigated an alternative approach for emergency care delivery comprised of SNF-based telemedicine services provided by emergency physicians (EP). We compared this on-site emergency care option to traditional ED-based care, evaluating hospital admission rates following care by an EP. Methods We conducted a retrospective, observational study of SNF residents who underwent emergency evaluation between January 1, 2017–January 1, 2018. The intervention group was comprised of residents at six urban SNFs in the Northeastern United States, who received an on-demand telemedicine service provided by an EP. The comparison group consisted of residents of SNFs that did not offer on-demand services and were transferred via ambulance to the ED. Using electronic health record data from both the telemedicine and ambulance transfers, our primary outcome was the odds ratio (OR) of a hospital admission. We also conducted a subanalysis examining the same OR for the three most common chronic disease-related presentations found among the telemedicine study population. Results A total of 4,606 patients were evaluated in both the SNF-based intervention and ED-based comparison groups (n=2,311 for SNF based group and 2,295 controls). Patients who received the SNF-based acute care were less likely to be admitted to the hospital compared to patients who were transferred to the ED in our primary and subgroup analyses. Overall, only 27% of the intervention group was transported to the ED for additional care and presumed admission, whereas 71% of the comparison group was admitted (OR for admission = 0.15 [9% confidence interval, 0.13–0.17]). Conclusion The use of an EP-staffed telemedicine service provided to SNF residents was associated with a significantly lower rate of hospital admissions compared to the usual ED-based care for a similarly aged population of SNF residents. Providing SNF-based care by EPs could decrease costs associated with hospital-based care and risks associated with hospitalization, including cognitive and functional decline, nosocomial infections, and falls.
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Affiliation(s)
- Joshua W Joseph
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Maura Kennedy
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Larry A Nathanson
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | | | | | - Amy Stuck
- West Health Institute, La Jolla, California
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Geddes MR, O'Connell ME, Fisk JD, Gauthier S, Camicioli R, Ismail Z. Remote cognitive and behavioral assessment: Report of the Alzheimer Society of Canada Task Force on dementia care best practices for COVID-19. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12111. [PMID: 32999916 PMCID: PMC7507991 DOI: 10.1002/dad2.12111] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Despite the urgent need for remote neurobehavioral assessment of individuals with cognitive impairment, guidance is lacking. Our goal is to provide a multi-dimensional framework for remotely assessing cognitive, functional, behavioral, and physical aspects of people with cognitive impairment, along with ethical and technical considerations. METHODS Literature review on remote cognitive assessment and multidisciplinary expert opinion from behavioral neurologists, neuropsychiatrists, neuropsychologists, and geriatricians was integrated under the auspices of the Alzheimer Society of Canada Task Force on Dementia Care Best Practices for COVID-19. Telephone and video approaches to assessments were considered. RESULTS Remote assessment is shown to be acceptable to patients and caregivers. Informed consent, informant history, and attention to privacy and autonomy are paramount. A range of screening and domain-specific instruments are available for telephone or video assessment of cognition, function, and behavior. Some neuropsychological tests administered by videoconferencing show good agreement with in-person assessment but still lack validation and norms. Aspects of the remote dementia-focused neurological examination can be performed reliably. DISCUSSION Despite challenges, current literature and practice support implementation of telemedicine assessments for patients with cognitive impairment. Convergence of data across the clinical interview, reliable and brief remote cognitive tests, and remote neurological exam increase confidence in clinical interpretation and diagnosis.
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Affiliation(s)
- Maiya R. Geddes
- Department of Neurology and NeurosurgeryMontreal Neurological InstituteMcGill UniversityMontrealCanada
- McGill Center for Studies in AgingMcGill UniversityVerdunCanada
- Departments of Psychiatry and NeurologyBrigham and Women's HospitalHarvard Medical SchoolBostonUSA
| | - Megan E. O'Connell
- Department of PsychologyUniversity of SaskatchewanSaskatoonCanada
- Canadian Center for Health & Safety in AgricultureMedicineUniversity of SaskatchewanSaskatoonCanada
| | - John D. Fisk
- Department of PsychiatryDalhousie UniversityHalifaxCanada
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxCanada
- Department of MedicineDalhousie UniversityHalifaxCanada
| | - Serge Gauthier
- McGill Center for Studies in AgingMcGill UniversityVerdunCanada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute and Department of MedicineDivision of NeurologyUniversity of AlbertaEdmontonCanada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteO'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
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Coco L, Davidson A, Marrone N. The Role of Patient-Site Facilitators in Teleaudiology: A Scoping Review. Am J Audiol 2020; 29:661-675. [PMID: 32692575 DOI: 10.1044/2020_aja-19-00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Teleaudiology helps improve access to hearing health care by overcoming the geographic gap between providers and patients. In many teleaudiology encounters, a facilitator is needed at the patient site to help with hands-on aspects of procedures. The aim of this study was to review the scope and nature of research around patient-site facilitators in teleaudiology. We focused on identifying the facilitators' background, training, and responsibilities. Method To conduct this scoping review, we searched PubMed, CINAHL, and Embase. To be included, studies needed to address teleaudiology; be experimental/quasi-experimental, correlational/predictive, or descriptive; be published in English; and include the use of a facilitator at the patient location. Results A total of 82 studies met the inclusion criteria. The available literature described a number of different individuals in the role of the patient-site facilitator, including audiologists, students, and local aides. Fifty-seven unique tasks were identified, including orienting the client to the space, assisting with technology, and assisting with audiology procedures. The largest number of studies (n = 42) did not describe the facilitators' training. When reported, the facilitators' training was heterogenous in terms of who delivered the training, the length of the training, and the training content. Conclusions Across studies, the range of duties performed by patient-site facilitators indicates they may have an important role in teleaudiology. However, details are still needed surrounding their background, responsibilities, and training. Future research is warranted exploring the role of the patient-site facilitator, including their impact on teleaudiology service delivery. Supplemental Material https://doi.org/10.23641/asha.12475796.
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Affiliation(s)
- Laura Coco
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
| | - Alyssa Davidson
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson
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Abstract
Purpose of Review The prevalence of neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD), is rising as the global population ages. Access to specialist care, which improves outcomes, is insufficient and disease-related disability makes in-person physician visits burdensome. Telehealth is one potential means for improving access to care. The purpose of this manuscript is to review recent publications on telemedicine in AD and PD. Recent Findings Telemedicine is feasible in AD and PD and acceptable to patients and their caregivers. Compared with in-person visits, telemedicine reduces visit-associated travel and time. Telemedicine can be used for rehabilitative therapies, to administer cognitive tests, and to support caregivers. Access to telemedicine results in changes in patient care including medication adjustments and referrals for therapies and supports. Summary The use of telemedicine in AD and PD stands to decrease burden on patients and increase access to specialty care. Barriers to the expansion of telemedicine care include lack of widespread broadband access, state licensure requirements, and inconsistent reimbursement. More outcomes-based prospective telemedicine studies are needed.
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Frumkin K. Toppling Oranges: Death, Disability, Decline, and Readmission of Community-Dwelling Elderly Patients After an Emergency Department Visit. J Emerg Med 2020; 58:339-345. [PMID: 32005609 DOI: 10.1016/j.jemermed.2019.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Every emergency department (ED) faces both a rising tide and a revolving door of elderly patients. Unplanned short-term returns after a recent ED evaluation or hospital admission are sentinel events. Consequences include substantial functional decline, reduced health-related quality of life, and increased risk of dependency or death. Returning families, unaware of the significant likelihood of deterioration after an ED or hospital discharge, often harbor suspicions that something was missed. Literature describing the significant likelihood of functional decline in elderly patients after ED or hospital discharge is presented. Suggestions for incorporating the potential for subsequent deterioration into the evaluation of elderly ED patients and the discussions surrounding disposition decisions are included. DISCUSSION In addition to impacting patients and families, posthospitalization decline and short-term readmissions create serious burdens for hospitals and their EDs. Education, vigilance, specialized geriatric EDs, dedicated inpatient units, and ED access to outpatient services for the elderly can aid in the recognition and mitigation of postvisit functional decline and associated returns. Financial incentives for reducing short-term readmissions can translate into novel approaches and referral arrangements. CONCLUSIONS Currently, and for the foreseeable future, EDs are integral to predicting, identifying, and preventing functional decline in the elderly. For now, we are all Geriatric EDs.
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Affiliation(s)
- Kenneth Frumkin
- Emergency Medicine Department, Naval Medical Center, Portsmouth, Virginia
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