High-Intensity Telemedicine Reduces Emergency Department Use by Older Adults With Dementia in Senior Living Communities.
Suzanne M Gillespie, Erin B Wasserman, Nancy E Wood and 5 others
PMID 31315813WHAT IT FOUND
Unadjusted emergency visits did not differ significantly for dementia residents in senior living with the telemedicine program.
After adjustment, the annualized decrease was 24% versus a 4.5% increase in controls.
Key findings
01In the unadjusted comparison, emergency department use for subjects with dementia did not differ significantly between telemedicine and control groups, while subjects without dementia showed a significant decrease.
02After adjustment, older adults with dementia who had access to the telemedicine program had a greater decrease in all emergency department visits over time, with an annualized decrease of 24% versus a 4.5% increase in controls (p=0.006).
03For emergency department visits that resulted in hospitalization, older adults with dementia who had access to the telemedicine program had an annualized decrease of 25% versus an 11.3% increase in controls (p=0.005).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study came from one geriatrics practice in one metropolitan area, so the results may not apply to other settings. It was a secondary analysis of a study not established to answer this question. The adjusted models could only account for measured patient and facility factors. The unadjusted comparison did not show a significant difference in emergency department use for subjects with dementia. The positive adjusted result depends on the multivariable model. Control subjects included patients at intervention sites who did not consent. This may make groups differ in ways not measured. Telemedicine was available only on weekdays from 8a.m. to 6p.m. A weekend pilot was discontinued because of very low use. The study included senior living communities but no nursing homes, so it says nothing about nursing home residents. The paper did not evaluate cost savings, despite discussing potential financial impact.
Declared interests
The paper lists NIH extramural and U.S. government non-PHS research support. No author conflict-of-interest declaration is included in the supplied text.
The easy way to misread this
Do not read the 24% adjusted decrease as proof that telemedicine alone caused fewer emergency visits. The intervention included a telemedicine visit with a facilitator who gathered clinical information and performed medication reconciliation, plus provider review, communication, orders, and follow-up direction. The study did not test which component mattered.