Improving Safety of Transitions to Skilled Nursing Care Using Video-conferencing

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Abstract: Discharge from hospitals to skilled nursing facilities (SNFs) represents a challenging and potentially dangerous care transition due to gaps in communication and changes in providers, different medication formularies, and misaligned treatment plans. Due to their high burden of co-morbidities, multiple medications, and impaired adaptive mechanisms, older adults are particularly vulnerable to adverse outcomes. In response to this health care challenge, hospitalists and geriatricians at Beth Israel Deaconess Medical Center (BIDMC) developed a novel video-communication program called ECHO-CT (Extension for Community Healthcare Outcomes-Care Transitions). ECHO-CT uses a multidisciplinary case-based model to connect hospital-based physicians, social workers and pharmacists with post-acute care providers, to enhance communication and improve care transitions of elderly patients discharged to SNFs. Our pilot outcome data show that compared to matched control facilities undergoing usual care, those participating in ECHO-CT had significantly lower 30-day readmission rates (Odds Ratio 0.57; 95% CI 0.34 – 0.96; p=0.0353), lower 30-day total healthcare costs ($2,602.19 lower; 95% CI -$4,133.90- -$1,070.48; p=0.0009), and shorter average lengths of stay at the SNF (- 5.52 days; 95% CI -9.61- -1.43; p=0.0081). However, we do not know whether these results can be replicated when compared to a national sample, whether patient safety is improved, nor whether the ECHO-CT program can be exported to other hospitals and post-acute care facilities. Therefore, in this proposal we aim to determine the effect of a weekly video-technology-enabled communication between acute hospital-based and SNF-based providers on improving care transitions, reducing adverse outcomes, preventing rehospitalizations, and reducing total health care costs for vulnerable elderly Medicare beneficiaries. Our specific aims are to: 1) replicate the ECHO-CT program on a larger scale in a tertiary and community-based hospital network of SNFs; 2) test the hypothesis that SNFs participating in the ECHO-CT intervention will demonstrate: a) fewer 30-day hospital readmissions, b) lower 30-day health care costs, c) shorter lengths of stay in the SNF, and d) fewer adverse safety outcomes compared to Medicare patients in a large group of similar New England SNFs; and 3) assess operational challenges and stakeholder satisfaction with the ECHO-CT program and use this information to develop the protocols and tools necessary for the future dissemination of ECHO-CT to other medical centers. The expertise of our team at Harvard Medical School and availability of Medicare Claims and Minimum Data Set data from Brown University will help assure the project’s success.