title: A multicenter study of ICU telemedicine reengineering of adult critical care.
abstract: BACKGROUND
  Few studies have evaluated both the overall effect of ICU telemedicine programs and the effect of individual components of the intervention on clinical outcomes.
  
  
  METHODS
  The effects of nonrandomized ICU telemedicine interventions on crude and adjusted mortality and length of stay (LOS) were measured. Additionally, individual intervention components related to process and setting of care were evaluated for their association with mortality and LOS.
  
  
  RESULTS
  Overall, 118,990 adult patients (11,558 control subjects, 107,432 intervention group patients) from 56 ICUs in 32 hospitals from 19 US health-care systems were included. After statistical adjustment, hospital (hazard ratio [HR]=0.84; 95% CI, 0.78-0.89; P<.001) and ICU (HR=0.74; 95% CI, 0.68-0.79; P<.001) mortality in the ICU telemedicine intervention group was significantly better than that of control subjects. Moreover, adjusted hospital LOS was reduced, on average, by 0.5 (95% CI, 0.4-0.5), 1.0 (95% CI, 0.7-1.3), and 3.6 (95% CI, 2.3-4.8) days, and adjusted ICU LOS was reduced by 1.1 (95% CI, 0.8-1.4), 2.5 (95% CI, 1.6-3.4), and 4.5 (95% CI, 1.5-7.2) days among those who stayed in the ICU for ≥7, ≥14, and ≥30 days, respectively. Individual components of the interventions that were associated with lower mortality, reduced LOS, or both included (1) intensivist case review within 1 h of admission, (2) timely use of performance data, (3) adherence to ICU best practices, and (4) quicker alert response times.
  
  
  CONCLUSIONS
  ICU telemedicine interventions, specifically interventions that increase early intensivist case involvement, improve adherence to ICU best practices, reduce response times to alarms, and encourage the use of performance data, were associated with lower mortality and LOS.
authors.affiliation: Departments of Medicine, University of Massachusetts Medical School, Worcester, MA; Anesthesiology, University of Massachusetts Medical School, Worcester, MA; Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA; UMass Memorial Medical Center, Worcester, MA. Electronic address: craig.lilly@umassmed.edu.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Lilly
authors.affiliation: M.O.R.E. Data Analytics, LLC, Columbus, OH; Surgery, University of Massachusetts Medical School, Worcester, MA.
authors.forename: John M
authors.initials: JM
authors.lastname: McLaughlin
authors.affiliation: Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Huifang
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Quantitative Sciences, University of Massachusetts Medical School, Worcester, MA; Cell Biology, University of Massachusetts Medical School, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Baker
authors.affiliation: Graduate School of Nursing Sciences, Worcester, MA; UMass Memorial Medical Center, Worcester, MA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Cody
authors.affiliation: Departments of Medicine, University of Massachusetts Medical School, Worcester, MA; UMass Memorial Medical Center, Worcester, MA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Irwin
mesh_terms: D000328:Adult; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States