Clinical Performance of the Remote After-Hours Telemedicine Medical Officer of the Day (Tele-MOD) Program: A Cohort Study.
Christine E Kistler, Jennifer L McCoy, Monique Boudreaux-Kelly and 5 others
PMID 41253290WHAT IT FOUND
Emergency department visits, hospitalizations, readmissions, and costs were lower after the first Tele-MOD visit in 492 VA nursing home Veterans.
Most were managed in place, but this pre-post study cannot prove the program caused the reductions.
Key findings
01The Tele-MOD program managed 78% of Veterans in place.
02In the 30 days after the index Tele-MOD visit, VA emergency department use fell 30%, non-VA emergency department use fell 5.1%, VA hospitalizations fell 47.0%, and non-VA hospitalizations fell 9.2%.
03The combined 30-day readmission rate fell 54.9%, and average costs declined $45,538.03 per Veteran.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a pre-post observational study without a control group or randomization, so other changes over time could explain the lower utilization. It included only two VA nursing homes, so results may not apply to other VA or community nursing homes. Veterans on comfort care or hospice were included, and their goals of care may have made transfers less likely and exaggerated the program's apparent impact. The study did not assess how the program was implemented, what barriers or facilitators existed, or facility-level quality measures. Visit reasons were grouped by ICD-10 codes that were not mutually exclusive, so categories may overlap.
Declared interests
Publication types indicate NIH extramural and non-U.S. government research support. The PI and CEK serve on the JAMDA editorial board without financial compensation. The other authors have no conflicts of interest to disclose.
The easy way to misread this
Do not conclude that the Tele-MOD program caused the reductions in emergency department use, hospitalizations, readmissions, or cost. The study compared each Veteran's care before and after their own index visit in only two VA nursing homes, without a control group, and included residents on comfort care or hospice whose goals of care may have reduced transfers.