Evaluating Telemedicine for Acute Illnesses in Assisted Living Residences

描述（由申请人提供）：在迅速扩大的老年人人口中，现有的急性疾病医疗保健系统往往对他们的服务很差。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。远程医疗是一种在其他弱势群体中已证明有效的商业技术，可使老年人受益。健康电子接入（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脆弱的老年人。拟议的研究旨在开发和评价一种远程医疗强化护理模式，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（艾德）的使用率，降低医疗保健的净成本，减少门诊护理敏感条件的住院治疗，提高随叫随到的临床医生和艾德之间的沟通质量，提高利益相关者的满意度，并提高AHRQ患者安全调查测量的患者安全性。战略，促进实施，接受和成功的heA在辅助生活住宅将确定使用定性方法。获得的知识将为广泛传播HeA强化护理模式的努力提供信息，部分是通过开发工具包。在这个多学科研究小组成员先前成功的基础上，这项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;评估为患有慢性病的老年人提供的护理;评估技术对成本和结果的影响;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扩大，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用性。拟议的远程医疗方案有可能克服这些障碍，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;这反过来又将促进远程医疗融入初级保健和紧急医疗系统，以改善弱势老年人的护理。

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.