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

摘要： 从医院出院到专业护理机构（SNF）是一个具有挑战性和潜在危险的 由于沟通方面的差距和提供者的变化、不同的药物处方，以及 治疗计划不一致由于他们的高负担的共病，多种药物，和受损 在适应机制方面，老年人特别容易受到不利后果的影响。针对这种健康 护理挑战，贝丝以色列女执事医疗中心（BIDMC）的医院医生和老年病学家制定了一项 一个新的视频通信程序，称为ECHO-CT（社区卫生保健结果护理扩展 过渡）。ECHO-CT使用基于多学科病例的模型，将医院医生、社会 工作人员和药剂师与急性后护理提供者，以加强沟通和改善护理 老年患者出院到SNF的过渡。我们的试点结果数据显示，与匹配的 接受常规护理的对照机构，那些参加ECHO-CT的患者的30天 再入院率（比值比0.57; 95% CI 0.34 - 0.96; p=0.0353），30天总医疗费用较低 （降低2，602.19美元; 95% CI -4，133.90美元-1，070.48美元; p=0.0009），在SNF的平均住院时间缩短（- 5.52天; 95% CI -9.61- -1.43; p=0.0081）。然而，我们不知道这些结果是否可以复制 与国家样本相比，患者安全性是否得到改善，ECHO-CT程序是否 可以出口到其他医院和急性后护理设施。因此，在本提案中，我们的目标是 确定每周一次基于视频技术的急诊医院与 基于SNF的提供者改善护理过渡，减少不良后果，防止再住院， 并减少弱势老年医疗保险受益人的总医疗保健费用。我们的具体目标是：1） 在SNF的三级和社区医院网络中更大规模地复制ECHO-CT计划; 2)检验参与ECHO-CT干预的SNF将证明：a）少于30天 再次入院，B）降低30天的医疗费用，c）缩短SNF的住院时间，d）减少 在一大组相似的新英格兰SNF中，与Medicare患者相比，不良安全性结局;以及3） 评估ECHO-CT计划的运营挑战和利益相关者满意度，并利用这一点 信息，以制定必要的协议和工具，以便将来将ECHO-CT传播给其他 医疗中心。我们在哈佛医学院的团队的专业知识和医疗保险索赔的可用性， 来自布朗大学的最小数据集数据将有助于确保该项目的成功。

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.