Telegeriatrics - A Pilot Project to Reduce Unnecessary Hospital Admissions of Nursing Home Residents in Singapore

H. J. Toh, Chia J., E. Koh, K. Lam, G. C. Magpantay, C. M. De Leon, J. A. Low

2015

Abstract

Geriatric specialists have been scarce in Singapore and this has drawn attention to a rising need in providing quality care for the ageing society. Access to geriatric care could decrease nursing home to acute hospital transfers, thus improving residents’ quality of life. A pilot project implemented by an acute hospital in Singapore aims to use videoconferencing systems to improve access to geriatric specialist care for nursing homes and thereby reduce unnecessary acute hospital admissions. We aim to assess the impact of the level of engagement with Telegeriatrics has on nursing home to hospital transfer rates. Two nursing homes were recruited from December 2010 to March 2014. A total of 379 telemedicine consultation episodes were conducted over this period. Hospital admission rates were monitored over a 2-year period and compared against the nursing home’s level of engagement with Telegeriatrics. The more-engaged nursing home reported a significant decrease of 29% in hospital admission rates. In contrast, the less-engaged nursing home only reported a 6% decrease. The findings show a reduction in hospital admission rate for both nursing homes. When the two nursing homes were compared, the nursing home that was more engaged with Telegeriatrics had a lower rate of unnecessary hospital admission. Telegeriatrics has the potential to reduce unnecessary hospitalisation frequently experienced by nursing home residents. Furthermore, a decrease in hospital readmission rates enables hospital beds to be better utilised, reduces medical spending and relieves residents’ distress.

References

  1. Kim, H. et al., 2001. 'Potentially preventable hospitalizations among older adults with diabetes.78 The American Journal of Managed Care, vol. 17, no. 1, pp. 419-26.
  2. Wolff, J. L. et al., 2002. 'Prevalence, Expenditures, and Complications of Multiple Chronic Conditions in the Elderly.78 Archives of Internal Medicine, vol. 162, pp. 2269-276.
  3. Cheah, J. and Heng, B.H., 2001. 'Implementing chronic disease management in the public healthcare sector in Singapore: the role of hospitals.78 World Hospitals and Health Services, vol. 37, no. 3, pp.19-23, 40-3.
  4. Cheah, J., 2001. 'Chronic disease management: a Singapore perspective.78 BMJ, vol. 323, no.7319, pp. 990-993.
  5. Tan, J. (2013, February 19). Hospital-Acquired Infections. The New Paper, p. 7.
  6. Tinetti, M. E. et al., 1994. 'A multifactorial intervention to reduce the risk of falling among elderly people living in the community.78 The New England Journal of Medicine, vol. 331, pp. 821-827.
  7. Burgio, K. L. et al., 1998. 'Behavioral vs drug treatment for urge urinary incontinence in older women: A randomized controlled trial.78 The Journal of the American Medical Association, vol. 280, pp. 1995- 2000.
  8. Inouye, S. K. et al., 1999. 'A multicomponent intervention to prevent delirium in hospitalized older patients.78 The New England Journal of Medicine, vol. 340, pp. 669- 676.
  9. Day, P. and Rasmussen, P., 2004. 'What is the evidence for the effectiveness of specialist geriatric services in acute, post-acute and sub-acute settings? A critical appraisal of the literature.78 New Zealand Health Technology (NZHTA) Report, vol. 7, no. 3, pp. 1-169.
  10. Ellis, G. et al., 2011. 'Comprehensive geriatric assessment for older adults admitted to hospital: metaanalysis of randomised controlled trials.78 BMJ , vol. 343, d6553.
  11. Ouslander, J. G., 2009. 'Reducing potentially avoidable hospitalizations of nursing home residents: the INTERACT II project.78 Florida Medical Directors Association (FMDA) Progress Report.
  12. Moehr, J. R. et al., 2005. 'Video conferencing-based telehealth--its implications for health promotion and health care.78 Methods of Information in Medicine, vol. 44, no. 2, pp. 334-341.
  13. Casavant, D. W., et al. 2014. 'Trial of telemedicine for patients on home ventilator support: feasibility, confidence in clinical management and use in medical decision-making.78 Journal of Telemedicine and Telecare, vol. 20, no. 8, pp. 441-449.
  14. Graham, A. R., 2002. 'Tele education in medicine: why and how.78 Riv Med Lab - JLM, vol. 3, no. 1, pp. 24- 26.
  15. Pedley, D. et al., 2003. 'A role for tele education in the centralization of accident and emergency services.78 Journal of Telemedicine and Telecare, vol. 9 no. 1, pp. 33-34.
  16. Mamun, K. et al., 2004. 'Polypharmacy and inappropriate medication use in Singapore nursing homes.78 Annals of the Academy of Medicine, Singapore, vol. 33, no. 1, pp. 49-52.
  17. Walsh, E. K. and Cussen, K., 2010. 78"Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.78 The Irish Medical Journal, vol. 103, no. 8, pp. 236-38.
  18. Finkers, F. et al., 2007. 'A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting.78 Journal of Clinical Pharmacy and Therapeutics, vol. 32, no. 5, pp. 469-76.
  19. Special issue on healthcare: healthy ageing and the future of public healthcare systems. European Commission (2009). Available at: http://ec.europa.eu/research/ social-sciences/pdf/efmn-special-issue-onhealthcare_en.pdf. (Accessed November 22, 2011).
  20. Smart, N., 2011. 'Exercise training for heart failure patients with and without systolic dysfunction: an evidence-based analysis of how patients benefit.78 Cardiology Research and Practice vol. 2011.
  21. Vander Werf, M., 2004. 'Ten critical steps for a successful telemedicine program.78 Studies in Health Technology and Informatics, vol.104, pp. 60-68.
  22. Taylor, J. et al., 2014. 'Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption.78 Journal of advanced nursing vol.71, no. 2.
  23. McLean, S. et al., 2012. 'Telehealthcare for chronic obstructive pulmonary disease. Cochrane Review and meta-analysis.78 British Journal of General Practice, vol. 62, no. 604, pp. 739-749.
  24. Ellis, D. G. et al., 2001. 'A telemedicine model for emergency care in a short-term correctional facility.78 Telemedicine journal and e-health, vol. 7, no. 2, pp. 87-92.
  25. Chaiyachati, K. H. et al., 2014. 'Continuity in a VA Patient-Centered Medical Home Reduces Emergency Department Visits.78 PLOS ONE vol. 9, no. 5.
  26. Grabowski, D. C. and O'Malley, A. J., 2014. 'Use Of Telemedicine Can Reduce Hospitalizations Of Nursing Home Residents And Generate Savings For Medicare.78 Health Affairs (Millwood), vol. 33, no. 2, pp. 244-250.
  27. Moehr, J. R., et al. 2006. 'Success factors for telehealth - a case study.78 International Journal of Medical Informatics, vol. 75, no. 10-11, pp. 755-63.
  28. Murray, E., et al., 2011. 'Why is it difficult to implement e-health initiatives? A qualitative study.78 Implementation Science, vol. 6, no. 6.
Download


Paper Citation


in Harvard Style

J. Toh H., J. C., Koh E., Lam K., C. Magpantay G., M. De Leon C. and A. Low J. (2015). Telegeriatrics - A Pilot Project to Reduce Unnecessary Hospital Admissions of Nursing Home Residents in Singapore . In Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health - Volume 1: ICT4AgeingWell, ISBN 978-989-758-102-1, pages 91-96. DOI: 10.5220/0005436800910096


in Bibtex Style

@conference{ict4ageingwell15,
author={H. J. Toh and Chia J. and E. Koh and K. Lam and G. C. Magpantay and C. M. De Leon and J. A. Low},
title={Telegeriatrics - A Pilot Project to Reduce Unnecessary Hospital Admissions of Nursing Home Residents in Singapore},
booktitle={Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health - Volume 1: ICT4AgeingWell,},
year={2015},
pages={91-96},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0005436800910096},
isbn={978-989-758-102-1},
}


in EndNote Style

TY - CONF
JO - Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health - Volume 1: ICT4AgeingWell,
TI - Telegeriatrics - A Pilot Project to Reduce Unnecessary Hospital Admissions of Nursing Home Residents in Singapore
SN - 978-989-758-102-1
AU - J. Toh H.
AU - J. C.
AU - Koh E.
AU - Lam K.
AU - C. Magpantay G.
AU - M. De Leon C.
AU - A. Low J.
PY - 2015
SP - 91
EP - 96
DO - 10.5220/0005436800910096