Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations

Julia Driessen; Andro Bonhomme; Woody Chang; David A Nace; Dio Kavalieratos; Subashan Perera; Steven M Handler

doi:10.1016/j.jamda.2016.02.004

Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations

J Am Med Dir Assoc. 2016 Jun 1;17(6):519-24. doi: 10.1016/j.jamda.2016.02.004. Epub 2016 Mar 9.

Authors

Julia Driessen¹, Andro Bonhomme², Woody Chang³, David A Nace⁴, Dio Kavalieratos⁵, Subashan Perera⁶, Steven M Handler⁷

Affiliations

¹ Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA; Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
² University of Pittsburgh Medical Center, Pittsburgh, PA.
³ Department of Medicine, University of Pittsburgh Medical Center-Medical Education, Pittsburgh, PA.
⁴ Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
⁵ Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
⁶ Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA.
⁷ Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: handlersm@upmc.edu.

Abstract

Objective: Potentially avoidable hospitalizations (PAHs) of nursing home (NH) residents are common, costly, and can have significant economic consequences. Telemedicine has been shown to reduce emergency department and hospitalization of NH residents, yet adoption has been limited and little is known about provider's perceptions and desired functionality for a telemedicine program. The goal of this study was to survey a nationally representative sample of NH physicians and advanced practice providers to quantify provider perceptions and desired functionality of telemedicine in NHs to reduce PAHs.

Design/setting/participants/measurement: We surveyed physicians and advanced practice providers who attended the 2015 AMDA-The Society for Post-Acute and Long-Term Care Medicine Annual Conference about their perceptions of telemedicine and desired attributes of a telemedicine program for managing acute changes of condition associated with PAHs.

Results: We received surveys from 435 of the 947 conference attendees for a 45.9% response rate. Providers indicated strong agreement with the potential for telemedicine to improve timeliness of care and fill existing service gaps, while disagreeing most with the ideas that telemedicine would reduce care effectiveness and jeopardize resident privacy. Responses indicated clear preferences for the technical requirements of such a program, such as high-quality audio and video and inclusion of an electronic stethoscope, but with varying opinions about who should be performing the consults.

Conclusion: Among NH providers, there is a high degree of confidence in the potential for a telemedicine solution to PAHs in NHs, as well as concrete views about features of such a solution. Such consensus could be used to drive an approach to telemedicine for PAHs in NHs that retains the theoretical strengths of telemedicine and reflects the needs of facilities, providers, and patients. Further research is needed to objectively study the impact of successful telemedicine implementations on patient, provider, and economic outcomes.

Keywords: Nursing homes; hospital readmission; hospitalization; telehealth; telemedicine.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Advanced Practice Nursing
Aged
Attitude of Health Personnel*
Female
Hospitalization* / statistics & numerical data
Humans
Male
Nursing Homes*
Patient Readmission*
Physicians / psychology
Surveys and Questionnaires
Telemedicine*
United States

Abstract

Publication types

MeSH terms

Grants and funding