Evaluating Telemedicine for Acute Illnesses in Assisted Living Residences

描述(由申请人提供)：在迅速增长的老年人口中，现有的急性疾病医疗保健系统经常为他们提供糟糕的服务。许多因素限制了这些患者获得安全、高效、高质量、低成本、急诊护理的机会。远程医疗是一种商业可用的技术，在其他弱势群体中证明了有效性，可能会使老年人受益。Health-e-Access(HEA)远程医疗网络是一种新的、高效的以患者为中心的急性疾病护理方法，使临床医生能够在他们的住所评估和治疗脆弱的老年人。拟议的研究旨在开发和评估远程医疗增强的护理模式，以改善获得安全、高质量的急性疾病护理的机会；促进适当使用卫生服务；并减少不必要的支出。具体地说，这项研究将在辅助生活住宅的社区网络中实施HEA。它将评估远程医疗将降低急诊科(ED)使用率、降低医疗保健净成本、减少因门诊敏感情况而住院的人数、改善随叫随到的临床医生与急诊室之间的通信质量、提高利益相关者满意度以及根据AHRQ患者安全调查衡量的患者安全的假设。将使用定性方法确定促进辅助生活住宅中HEA的实施、接受和成功的策略。所获得的知识将有助于广泛传播HEA增强护理模式的努力，部分是通过开发工具包来实现的。在这个多学科研究团队成员先前成功的基础上，这项研究将解决主要利益相关者以及AHRQ和Medicare证据优先事项，包括：提高质量和患者安全性；更具成本效益的护理模式；对患有慢性病的老年人提供的护理的评估；对技术对成本和结果的影响的评估；以及改善获得护理的机会。 公共卫生相关性：项目叙述--与公共卫生的相关性。美国的老年人口正在迅速增长，导致对安全、高效、高质量、低成本的急性护理的需求增加。许多因素限制了这种护理的可获得性。拟议的远程医疗方案有可能消除这些障碍，并改善获得这一关键服务的机会。成功完成研究将证明远程医疗作为急性护理模式的一部分的价值，并阐明对其接受、可持续性和传播至关重要的促进和阻碍因素；这反过来将促进将远程医疗纳入初级保健和紧急医疗系统，以改善对易受伤害的老年人的护理。

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. PUBLIC HEALTH RELEVANCE: Project Narrative - Relevance to Public Health. The older adult population in the United States is rapidly expanding, resulting in increased demands for safe, efficient, high-quality, low cost acute care. Many factors limit the availability of this care. The proposed telemedicine program has the potential to obviate these barriers and to improve access to this critical service. Successful study completion will demonstrate the value of telemedicine as part of an acute care model and explicate facilitating and obstructing factors that are critical to its acceptance, sustainability, and dissemination; this, in turn will promote the integration of telemedicine into primary care and emergency medical systems to improve the care of vulnerable, older adults.