title: High-Intensity Telemedicine Decreases Emergency Department Use by Senior Living Community Residents.
abstract: BACKGROUND
  The failure to provide timely acute illness care can lead to adverse consequences or emergency department (ED) use. We evaluated the effect on ED use of a high-intensity telemedicine program that provides acute illness care for senior living community (SLC) residents.
  
  
  METHODS
  We performed a prospective cohort study over 3.5 years. Six SLCs cared for by a primary care geriatrics practice were intervention facilities, with the remaining 16 being controls. Consenting patients at intervention facilities could access telemedicine for acute illness care. Patients were provided patient-to-provider, real-time, or store-and-forward high-intensity telemedicine (i.e., technician-assisted with resources beyond simple videoconferencing) to diagnose and treat acute illnesses. The primary outcome was the rate of ED use.
  
  
  RESULTS
  We enrolled 494 of 705 (70.1%) subjects/proxies in the intervention group; 1,058 subjects served as controls. Control and intervention subjects visited the ED 2,238 and 725 times, respectively, with 47.3% of control and 43.4% of intervention group visits resulting in discharge home. Among intervention subjects, ED use decreased at an annualized rate of 18% (rate ratio [RR]=0.82; 95% confidence interval [CI], 0.70-0.95), whereas in the control group there was no statistically significant change in ED use (RR=1.01; 95% CI, 0.95-1.07; p=0.009 for group-by-time interaction). Primary care use and mortality were not significantly different.
  
  
  CONCLUSIONS
  High-intensity telemedicine significantly reduced ED use among SLC residents without increasing other utilization or mortality. This alternative to traditional acute illness care can enhance access to acute illness care and should be integrated into population health programs.
authors.affiliation: 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.|2 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.|3 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.affiliation: 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.|2 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Wasserman
authors.affiliation: 4 Department of Biostatistics, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.affiliation: 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.|3 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Gillespie
authors.affiliation: 2 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.|5 Department of Surgery, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.affiliation: 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Wood
authors.affiliation: 3 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Dallas
authors.initials: D
authors.lastname: Nelson
authors.affiliation: 2 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Ann
authors.initials: A
authors.lastname: Dozier
authors.affiliation: 6 Department of Pediatrics, University of Rochester School of Medicine and Dentistry , Rochester, New York.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: McConnochie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D057187:Independent Living; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D018570:Risk Assessment; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States
keywords: acute illness; aging; telemedicine