title: A pilot study of usefulness of clinician-patient videoconferencing for making routine medical decisions in the nursing home.
abstract: OBJECTIVE
  To pilot and assess the role of videoconferencing in clinicians' medical decision-making and their interactions with nursing home residents (NHRs).
  
  
  METHODS
  Paired virtual and bedside examinations. Face-to-face (FTF) examination of NHRs by off-site clinicians immediately followed videoconferencing between the same clinician-NHR pair.
  
  
  METHODS
  A 240-bed, county-managed, urban nursing home.
  
  
  METHODS
  NHRs (n=35) and clinicians (n=3) receiving or providing routine care between 2002 and 2003.
  
  
  METHODS
  Orders generated by clinicians, clinicians' ratings of videoconferencing, and coded review of video encounters. After both examinations, clinicians rated the encounters and generated orders necessary for NHRs. Orders were categorized and counted according to timing (before or after the FTF visit). Clinician-NHR interactions were assessed using coding videos with a 31-item instrument.
  
  
  RESULTS
  For 71% of the encounters, clinicians stated that videoconferencing facilitated their assessment. Difficulties included sound quality (19%) and participants' familiarity with videoconferencing (7%). Although NHRs were alert in 50% of encounters, 62% of alert NHRs did not indicate understanding of the recommended treatment.
  
  
  CONCLUSIONS
  FTF examination was superior for most assessments, but videoconferencing was judged to be valuable, especially for wound care. Even when NHRs were alert, informed medical decision-making by NHRs with their clinicians was limited. Enhancing videoconferencing quality and providing more training about informed decision-making using videoconferencing might improve the effectiveness of the technology.
authors.affiliation: Regenstrief Institute, Inc., Indianapolis, Indiana 46202, USA. mlaflamme@regenstrief.org
authors.forename: Mark R
authors.initials: MR
authors.lastname: Laflamme
authors.forename: David C
authors.initials: DC
authors.lastname: Wilcox
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Sullivan
authors.forename: Gunther
authors.initials: G
authors.lastname: Schadow
authors.forename: Donald
authors.initials: D
authors.lastname: Lindbergh
authors.forename: Jill
authors.initials: J
authors.lastname: Warvel
authors.forename: Heydon
authors.initials: H
authors.lastname: Buchanan
authors.forename: Terry
authors.initials: T
authors.lastname: Ising
authors.forename: Greg
authors.initials: G
authors.lastname: Abernathy
authors.forename: Susan M
authors.initials: SM
authors.lastname: Perkins
authors.forename: Joanne
authors.initials: J
authors.lastname: Daggy
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
authors.forename: Paul
authors.initials: P
authors.lastname: Dexter
authors.forename: Clement J
authors.initials: CJ
authors.lastname: McDonald
authors.forename: Michael
authors.initials: M
authors.lastname: Weiner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010817:Physician-Patient Relations; D010865:Pilot Projects; D014584:User-Computer Interface; D049269:Videoconferencing / Q000592:standards