Improving Transitions to Postacute Care for Elderly Patients Using a Novel Video-Conferencing Program: ECHO-Care Transitions - 17/09/17
, J. Elyse Krupp, MPH a, Alyssa B. Dufour, PhD a, b, c, Mousumi Sircar, MD a, b, Thomas G. Travison, PhD b, c, Alan Abrams, MD a, b, Grace Farris, MD a, Melissa L.P. Mattison, MD b, d, Lewis A. Lipsitz, MD a, b, cAbstract |
Purpose |
Within 30 days of hospital discharge to a skilled nursing facility, older adults are at high risk for death, re-hospitalization, and high-cost health care. The purpose of this study was to examine whether a novel videoconference program called Extension for Community Health Outcomes-Care Transitions (ECHO-CT) that connects an interdisciplinary hospital-based team with clinicians at skilled nursing facilities reduces patient mortality, hospital readmission, skilled nursing facility length of stay, and 30-day health care costs.
Methods |
We undertook a prospective cohort study comparing cost and health care utilization outcomes between ECHO-CT facilities and matched comparisons from January 2014-December 2014.
Results |
Thirty-day readmission rates were significantly lower in the intervention group (odds ratio 0.57; 95% CI, 0.34-0.96; P-value .04), as were the 30-day total health care cost ($2602.19 lower; 95% CI, −$4133.90 to −$1070.48; P-value <.001) and the average length of stay at the skilled nursing facility (−5.52 days; 95% CI, −9.61 to −1.43; P = .001). The 30-day mortality rate was not significantly lower in the intervention group (odds ratio 0.38; 95% CI, 0.11-1.24; P = .11).
Conclusion |
Patients discharged to skilled nursing facilities participating in the ECHO-CT program had shorter lengths of stay, lower 30-day rehospitalization rates, and lower 30-day health care costs compared with those in matched skilled nursing facilities delivering usual care. ECHO-CT may improve patient transitions to postacute care at lower overall cost.
Le texte complet de cet article est disponible en PDF.Keywords : Care transitions, ECHO, Readmissions
Plan
| Funding: This research was funded by a grant from The Donald W. Reynolds Foundation and matched by funds from Beth Israel Deaconess Care Organization and the Beth Israel Deaconess Medical Center Department of Medicine. The D.W. Reynolds Foundation had no role in the data collection, analysis, or writing of the paper. Beth Israel Deaconess Care Organization partially funded the project and representatives from this organization reviewed the final draft of this paper prior to submission. MS received fellowship funding from the Hartford Foundation and was supported by grant 10-044 from the Health Services and Research Administration. LAL holds the Irving and Edyth S. Usen and Family Chair in Geriatric Medicine at Hebrew SeniorLife, Boston, Mass and was supported by grants R01 AG041785 and R01 AG025037 from the National Institute on Aging and by grant P30 AG048785 from the Boston Roybal Center for Active Lifestyle Interventions (RALI Boston). |
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| Conflict of Interest: None. |
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| Authorship: LAL and MLPM conceived of the project. LAL, MLPM, and GF served as principal investigators for ECHO-CT during the period studied. JEK helped collect data, conducted the statistical analysis, and contributed to revisions and submission of the manuscript. AA provided patient data and participated in manuscript preparation. TGT and ABD guided the statistical analysis. MS wrote the first draft of the manuscript. ABM wrote subsequent and final drafts of the manuscript and served as a principal investigator for the ECHO-CT project at the time of article submission. All of the authors made comments and revisions to the final manuscript. |
Vol 130 - N° 10
P. 1199-1204 - octobre 2017 Retour au numéro
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