Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.
Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.
Keith J
KJ
Mueller
Andrew J
AJ
Potter
A Clinton
AC
MacKinney
Marcia M
MM
Ward
D003695:Delivery of Health Care / Q000458:organization & administration*; D004630:Emergencies; D004638:Emergency Treatment; D018166:Health Care Reform; D019538:Health Care Surveys; D006780:Hospitals, Rural / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D018802:Patient-Centered Care / Q000458:organization & administration; D010821:Physicians, Family / Q000458:organization & administration; D058996:Quality Improvement; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States
Access To Care; Information Technology; Organization and Delivery of Care; Quality Of Care; Rural Health Care