Mathematica Inc., Princeton, New Jersey, USA.
Mathematica Inc., Ann Arbor, Michigan, USA.
Health Serv Res. 2022 Oct;57(5):1191-1200. doi: 10.1111/1475-6773.13936. Epub 2022 Feb 21.
To assess the effects of eLongTermCare (eLTC), a telehealth program implemented by an integrated health system in 45 nursing homes across the Midwest, on the use of acute hospital services and total expenditures for Medicare residents.
Minimum Data Set, Medicare fee-for-service claims, and enrollment data from 2013 to 2018.
We used a longitudinal difference-in-differences design to estimate the changes in outcomes for treatment beneficiaries before and after participating in the eLTC program, relative to changes for the matched comparison beneficiaries over the same period. We measured outcomes over a 24-month follow-up period, including total Medicare spending, emergency department (ED) visits, hospitalizations, and the likelihood of readmission.
DATA COLLECTION/EXTRACTION METHODS: Using administrative data, we identified treatment beneficiaries who stayed at participating nursing facilities during the program period and matched comparison beneficiaries with similar baseline characteristics from non-participating facilities in the same geographic locations.
For long-term care residents, the eLTC program led to an estimated reduction of 73 ED visits per 1000 beneficiaries (p < 0.01, 8.6% effect) over the two-year follow-up period. The estimated effects for this group were concentrated among beneficiaries who entered the nursing home after program startup, with sizable reductions in hospitalizations, ED visits, and spending. For skilled care residents, the program was associated with an estimated reduction of 85 ED visits per 1000 beneficiaries (p = 0.03, 9.7% effect), but had no discernible effect on their hospitalizations or total Medicare spending.
Telehealth can be a valuable tool for nursing homes to enhance care coordination and provide timely access to care, leading to lower spending for nursing home residents. Future research needs to explore payment methods that encourage telehealth expansion in nursing homes.
评估 eLongTermCare（eLTC）的效果，这是一个由一个综合医疗系统在中西部的 45 家养老院实施的远程医疗计划，该计划对医疗保险居民的急性医院服务使用和总支出的影响。
最低数据组、医疗保险按服务收费的索赔和 2013 年至 2018 年的注册数据。
我们使用纵向差异-差异设计来估计在接受 eLTC 计划前后治疗受益人的结果变化，相对于同一时期参与匹配比较受益人的变化。我们在 24 个月的随访期间衡量了结果，包括医疗保险总支出、急诊部（ED）就诊、住院和再次入院的可能性。
数据收集/提取方法：使用行政数据，我们确定了在计划期间住在参与的养老院的治疗受益人和从同一地理位置的非参与设施中具有类似基线特征的匹配比较受益人的身份。
对于长期护理居民，eLTC 计划导致每 1000 名受益人在两年的随访期间估计减少 73 次 ED 就诊（p<0.01，效应为 8.6%）。该组的估计效果集中在计划启动后进入养老院的受益人身上，住院、ED 就诊和支出都有大幅减少。对于熟练护理居民，该计划与每 1000 名受益人估计减少 85 次 ED 就诊有关（p=0.03，效应为 9.7%），但对他们的住院或医疗保险总支出没有明显影响。
远程医疗可以成为养老院增强护理协调和提供及时护理的有价值的工具，从而降低养老院居民的支出。未来的研究需要探讨鼓励养老院扩大远程医疗的支付方式。
