Evaluating Telemedicine for Acute Illnesses in Assisted Living Residences

描述（由申请人提供）：在快速增长的老年人人口中，现有的急性病医疗保健系统往往不能很好地为他们服务。许多因素限制了这些患者获得安全、高效、高质量、低成本的急性护理。远程医疗是一种商业化技术，已证明对其他弱势群体有效，可能使老年人受益。健康电子通道（HeA）远程医疗网络是一种以患者为中心的急性疾病护理的新颖而有效的方法，使临床医生能够在其住所评估和治疗易受伤害的老年人。提出的研究旨在开发和评估远程医疗增强护理模式，以改善获得安全，高质量的急性疾病护理的机会；促进适当利用保健服务；并减少不必要的开支。具体而言，该研究将在辅助生活住宅的社区网络中实施HeA。它将评估以下假设：远程医疗将降低急诊科（ED）使用率，降低医疗保健净成本，减少门诊护理敏感情况的住院率，提高随叫随到的临床医生与急诊科之间的沟通质量，提高利益相关者满意度，并改善AHRQ患者安全调查所衡量的患者安全。促进HeA在辅助生活住宅中的实施、接受和成功的策略将使用定性方法确定。所获得的知识将为广泛传播HeA强化护理模式的工作提供信息，部分是通过工具包开发。在该多学科研究团队成员先前成功的基础上，本研究将解决主要利益相关者和AHRQ和医疗保险证据优先事项的关注，包括：提高质量和患者安全；更具成本效益的护理模式；对患有慢性疾病的老年人提供的护理进行评估；评估技术对成本和结果的影响；改善获得医疗服务的机会。

DESCRIPTION (provided by applicant): The existing system of medical care for acute illness among the rapidly expanding population of older adults often serves them poorly. Many factors limit the access of these patients to safe, efficient, high quality, low cost, acute care. Telemedicine, a commercially-available technology with demonstrated effectiveness in other vulnerable populations, may benefit older adults. The Health-e-Access (HeA) telemedicine network is a novel and efficient approach to patient-centered acute illness care, enabling clinicians to evaluate and treat vulnerable older adults in their residences. The proposed study aims to develop and evaluate a telemedicine- enhanced care model that improves access to safe, high quality, acute illness care; fosters appropriate use of health services; and reduces unnecessary expenditures. Specifically, the study will implement HeA within a community network of assisted living residences. It will evaluate hypotheses that telemedicine will decrease the rate of emergency department (ED) use, decrease the net cost of healthcare, decrease hospitalization for ambulatory care sensitive conditions, improve the quality of communications between on-call clinicians and the ED, improve stakeholder satisfaction, and improve patient safety as measured by the AHRQ Survey on Patient Safety. Strategies that promote the implementation, acceptance, and success of HeA in assisted living residences will be determined using qualitative methods. Knowledge acquired will inform efforts to disseminate the HeA enhanced care model widely, in part through toolkit development. Building on prior success of this multidisciplinary research team's members, this study will address both concerns of major stakeholders and AHRQ and Medicare Evidentiary Priorities, including: improved quality and patient safety; more cost-effective care models; evaluation of care provided to older adults with chronic illnesses; assessment of technology's impact of cost and outcomes; and improved access to care.