Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York; Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
J Am Geriatr Soc. 2013 Nov;61(11):2000-7. doi: 10.1111/jgs.12523. Epub 2013 Oct 28.
Accessing timely acute medical care is a challenge for older adults. This article describes an innovative healthcare model that uses high-intensity telemedicine services to provide rapid acute care for older adults without requiring them to leave their senior living community (SLC) residences. This program, based in a primary care geriatrics practice that cares for SLC residents, is designed to offer acute care through telemedicine for complaints that are felt to need attention before the next available outpatient visit but not to require emergency department (ED) resources. This option gives residents access to care in their residence. Measures used to evaluate the program include successful completion of telemedicine visits, satisfaction of residents and caregivers with telemedicine care, and site of care that would have been recommended had telemedicine been unavailable. During the first 2 years of the program's operation, 281 of 301 requested telemedicine visits were completed successfully. Twelve residents were sent to an ED for care after the telemedicine visit. Ninety-four percent of residents reported being satisfied or very satisfied with telemedicine care. Had telemedicine not been available, residents would have been sent to an ED (48.1%) or urgent care center (27.0%) or been scheduled for an outpatient visit (24.4%). The project demonstrated that high-intensity telemedicine services for acute illnesses are feasible and acceptable and can provide definitive care without requiring ED or urgent care use. Continuation of the program will require evaluation demonstrating equal or better resident-level outcomes and the development of sustainable business models.
老年人及时获得急性医疗护理是一项挑战。本文介绍了一种创新的医疗保健模式，该模式利用高强度远程医疗服务为老年人提供快速急性护理，而无需离开他们的高级生活社区（SLC）住所。该计划基于一个初级保健老年医学实践，为 SLC 居民提供护理，旨在通过远程医疗为那些被认为需要在下一次门诊就诊前得到关注但不需要紧急部门（ED）资源的投诉提供急性护理。这种选择让居民能够在自己的住所接受护理。用于评估该计划的措施包括远程医疗访问的成功完成、居民和护理人员对远程医疗护理的满意度，以及如果远程医疗不可用，将推荐的护理地点。在该计划运营的头两年中，有 301 次请求的远程医疗访问中有 281 次成功完成。在远程医疗访问后，有 12 名居民被送往 ED 接受治疗。94%的居民报告对远程医疗护理满意或非常满意。如果没有远程医疗，居民将被送往 ED（48.1%）或紧急护理中心（27.0%），或安排门诊就诊（24.4%）。该项目表明，高强度远程医疗服务用于急性疾病是可行且可接受的，并且可以提供明确的护理，而无需使用 ED 或紧急护理。该计划的继续需要评估证明同等或更好的居民水平结果，并制定可持续的商业模式。
