title: Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study.
abstract: US nursing homes care for increasing numbers of residents with dementia and associated behavioral problems. They often lack access to specialized clinical expertise relevant to managing these problems. Project ECHO-AGE provides this expertise through videoconference sessions between frontline nursing home staff and clinical experts at an academic medical center. We hypothesized that ECHO-AGE would result in less use of physical and chemical restraints and other quality improvements in participating facilities.
  
  
  
  A 2:1 matched-cohort study comparing quality of care outcomes between ECHO-AGE facilities and matched controls for the period July 2012 to December 2013.
  
  
  
  Eleven nursing homes in Massachusetts and Maine.
  
  
  
  Nursing home staff and a hospital-based team of geriatrician, geropsychiatrist, and neurologist discussed anonymized residents with dementia.
  
  
  
  Biweekly online video case discussions and brief didactic sessions focused on the management of dementia and behavior disorders.
  
  
  
  The primary outcome variables were percentage of residents receiving antipsychotic medications and the percentage of residents who were physically restrained. Secondary outcomes included 9 other quality of care metrics from MDS 3.0.
  
  
  
  Residents in ECHO-AGE facilities were 75% less likely to be physically restrained compared with residents in control facilities over the 18-month intervention period (OR = 0.25, P = .05). Residents in ECHO-AGE facilities were 17% less likely to be prescribed antipsychotic medication compared with residents in control facilities (OR = 0.83, P = .07). Other outcomes were not significantly different.
  
  
  
  Preliminary evidence suggests that participation in Project ECHO-AGE reduces rates of physical restraint use and may reduce rates of antipsychotic use among long-term nursing home residents.
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA; Hebrew SeniorLife, Roslindale, MA; Harvard Medical School, Boston, MA. Electronic address: stephengordon@hsl.harvard.edu.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Gordon
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA; Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Dufour
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Monti
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Melissa L P
authors.initials: ML
authors.lastname: Mattison
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Angela G
authors.initials: AG
authors.lastname: Catic
authors.affiliation: Schneider Institutes for Health Policy, Brandeis University, Waltham, MA.
authors.forename: Cindy P
authors.initials: CP
authors.lastname: Thomas
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA; Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA.
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D006801:Humans; D008281:Maine; D008404:Massachusetts; D008505:Medical Staff, Hospital / Q000193:education; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education; D010865:Pilot Projects; D011446:Prospective Studies; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D049269:Videoconferencing
chemical_list: D014150:Antipsychotic Agents
keywords: Dementia; antipsychotics; nursing home; physical restraints; videoconferencing