title: High-Intensity Telemedicine Decreases Emergency Department Use for Ambulatory Care Sensitive Conditions by Older Adult Senior Living Community Residents.
abstract: BACKGROUND
  Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) are common among older adults. The high-intensity telemedicine model of care has been proposed as an innovative approach to expand access to acute illness care, thereby preventing ED visits. The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of ED use for ACSCs.
  
  
  METHODS
  We performed a prospective cohort study at a primary care geriatrics practice that provides care to 22 SLCs. Six SLCs selected as intervention facilities, with the remaining SLCs serving as controls. Consenting practice patients at intervention facilities could have patient-to-provider, real-time, or store-and-forward high-intensity telemedicine services to diagnose and treat illnesses. The primary outcome was the rate of ED visits for which the primary diagnosis was an "ambulatory-care-sensitive" condition by the Institute of Medicine, which we compared between control and intervention participants.
  
  
  RESULTS
  During the study period, control participants had 310 ED visits for ACSCs, for a rate of 0.195 visits/person-year. Intervention participants visited the ED for ACSCs 85 times, for a rate of 0.138 visits/person-year [unadjusted rate ratio (RR): 0.71, 95% confidence interval (CI): 0.53-0.94]. Among intervention participants, ED use for ACSCs decreased at an annual rate of 34% (RR: 0.661, 95% CI: 0.444-0.982), whereas, in the control group there was no statistically significant change in ED use over time (RR: 1.01, 95% CI: 0.90-1.14).
  
  
  CONCLUSIONS
  Providing acute illness care by high-intensity telemedicine to older adults residing in SLCs significantly decreases the rate of ED use for ACSCs over 1 year, compared with no change in the rate of ED use for ACSCs among the control group.
authors: Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address: mnshah@medicine.wisc.edu.
authors: Manish N
authors: MN
authors: Shah
authors: Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors: Erin B
authors: EB
authors: Wasserman
authors: Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address: suzanne_gillespie@urmc.rochester.edu.
authors: Suzanne M
authors: SM
authors: Gillespie
authors: Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors: Nancy E
authors: NE
authors: Wood
authors: Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors: Hongyue
authors: H
authors: Wang
authors: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors: Katia
authors: K
authors: Noyes
authors: Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors: Dallas
authors: D
authors: Nelson
authors: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors: Ann
authors: A
authors: Dozier
authors: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors: Kenneth M
authors: KM
authors: McConnochie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D011446:Prospective Studies; D017216:Telemedicine
keywords: Aging; acute illness; ambulatory care sensitive conditions; telemedicine