The system of medical care for older adults with acute illnesses often serves them poorly.
Many factors limit these patients' access to safe, patient-centered, efficient, high-quality,
acute care. These factors include a shortage of geriatricians and primary care physicians;
limited availability of timely, acute-illness, patient appointments; emergency department
(ED) crowding; interruptions to the continuity of care when patients use the ED; and poor
transitions of care from the ambulatory setting to the ED. These conditions foster
unnecessary ED use, adverse events in the ED for which older adults are particularly at-risk,
and unnecessary medical costs. As the population ages, the magnitude of these problems will
The overarching study goals are to develop and evaluate a telemedicine-enhanced care model
that improves access to safe, high-quality, acute illness care for older adults; fosters
appropriate use of health services; and reduces unnecessary expenditures. Specifically, this
study aims to:
1. Expand the existing pediatric HeA telemedicine network to older adults by providing
senior living communities (SLC) with an alternative on-site care option for individuals
with an acute illness episode.
Hypothesis 1: 90% of requested telemedicine visits will be successfully completed.
2. Evaluate the impact of the HeA telemedicine model on utilization, quality of care, and
Hypothesis 2: The rate of ED use will be lower at SLCs with access to care via
telemedicine, as compared to SLCs without such access to care.
Hypothesis 3: Quality of care and patient safety measures will be better for SLC
residents with access to telemedicine-enhanced care than for residents without this form
3. Evaluate the economic benefit of the care delivered through the telemedicine network.
Hypothesis 4: The net cost of healthcare per patient-month will be less for SLC
residents with access to telemedicine-enhanced care than for those without this form of
4. Use qualitative methods to identify strategies and assets that promote and conditions
that impede the implementation, acceptance, and success of the HeA telemedicine network
in SLCs. This knowledge will inform efforts to develop a toolkit to be used to
disseminate this technology broadly.