TELE-Cost: Evaluating Tele-Emergency Care in Costs and Outcomes for Rural Sepsis Patients
Study Details
Study Description
Brief Summary
Sepsis is a life-threatening emergency for which provider-to-provider telemedicine has been used to improve quality of care. The objective of this study is to measure the impact of rural tele-emergency consultation on long-term health care costs and outcomes through decreasing organ failure, hospital length-of-stay, and readmissions.
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
Sepsis is responsible for over 1.7 million hospitalizations at a cost of $26 billion annually, making it the most expensive acute care condition in US hospitals. High-quality early sepsis care has been associated with decreased organ failure, shorter ICU and hospital length-of-stay, and improved survival. Rural sepsis patients are more likely to be transferred to tertiary centers, and they also have higher mortality and health care costs. ED-based telemedicine (tele-ED) consultation between a rural provider and a board-certified emergency physician may deliver the expertise to reduce care delays and improve outcomes while avoiding unnecessary costs.
In 2017, the study team partnered with Avera eCARE, the largest tele-ED provider in North America, to implement a standard telemedicine-based sepsis care pathway. Subsequently, the investigators showed (using patient-level primary data collection across several networks) that tele-ED use was associated with improved adherence with international sepsis guidelines.
In addition to its association with short-term clinical outcomes, however, the study team hypothesize that telemedicine may also decrease costs. The investigators have shown that high-quality sepsis care is associated with decreased readmissions and post-discharge mortality. High quality care may also prevent organ failure, avoid ICU admissions, reduce mechanical ventilation and vasopressor use, decrease ICU and hospital length-of-stay, and decrease post-discharge care-primarily through reducing avoidable organ failure. All of these factors are likely to have a significant effect in terms of reducing healthcare cost.
The objective of the proposed project is to measure the effect of tele-ED consultation at reducing healthcare costs and long-term outcomes in sepsis patients in rural EDs. The following primary hypotheses will be tested:
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Total healthcare expenses and 90-day mortality will be lower in patients treated in a tele-ED hospital, with the effect primarily through reduced hospital length-of-stay and fewer readmissions.
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Total expenses and mortality will be lower in cases where tele-ED is used vs. matched controls in non-tele-ED hospitals.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Non-tele-ED hospital Patients receiving care in an ED that does not provide any tele-ED service |
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Tele-ED hospital Patients receiving care in an ED that uses tele-ED services, but patient care did NOT utilize this service |
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Tele-ED used Patient care was provided through tele-ED services |
Other: Telemedicine
Receiving care in a tele-ED hospital
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Outcome Measures
Primary Outcome Measures
- Total healthcare expenditures [From hospital admission until 30 days after discharge]
Defined as direct inpatient and outpatient payments to hospitals and physicians, skilled nursing care, home care, durable medical equipment, and ambulance costs from the ED visit until 30 days post-discharge. Drugs are not included.
Secondary Outcome Measures
- Number of participants who die within 90 days of hospital admission [From hospital admission until 90 days after admission]
90-day mortality
- Hospital length-of-stay [From date of hospitalization through hospital discharge, assessed up to 90 days]
Duration of hospitalization
- Number of participants requiring ICU care [From the date of hospital admission through hospital discharge or 90 days, whichever comes first, the number of participants who are treated in an intensive care unit]
Any admission to the ICU
- Emergency department costs [From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all emergency department health care expenditures]
Total healthcare expenditures related to emergency department care in current hospitalization
- Inpatient care costs [From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all inpatient health care expenditures]
Total healthcare expenditures related to inpatient care in current hospitalizations
- Inter-hospital transfer costs [From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all inter-hospital transfer health care expenditures]
Emergency medical services transfer costs and second emergency department costs (if transferred)
- Post-discharge costs [From the date of hospital discharge through 30 days after discharge, total health care expenditures health care expenditures]
Total healthcare expenditures
- Readmission costs [Between hospital discharge and 30 days after hospital discharge, related to inpatient re-hospitalization]
Total healthcare expenditures during readmission(s) within 30 days after initial hospital discharge
Eligibility Criteria
Criteria
Inclusion Criteria:
- Sepsis, according to ICD-10 codes
Exclusion Criteria:
- No infection diagnosed in the ED
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | University of Iowa Hospitals and Clinics | Iowa City | Iowa | United States | 52242 |
Sponsors and Collaborators
- Nicholas M Mohr
- Health Resources and Services Administration (HRSA)
Investigators
- Principal Investigator: Nicholas Mohr, MD, University of Iowa
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 202011064