Geriatric Research Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA.
U.S. Department of Veterans Affairs, Office of Primary Care, Washington, District of Columbia, USA.
Health Serv Res. 2023 Feb;58 Suppl 1(Suppl 1):16-25. doi: 10.1111/1475-6773.14058. Epub 2022 Sep 17.
To describe a feasibility pilot study for older adults that addresses the digital divide, unmet health care needs, and the 4Ms of Age-Friendly Health Systems via the emergency department (ED) follow-up home visits supported by telehealth.
Data sources were a pre-implementation site survey and pilot phase individual-level patient data from six US Department of Veterans Affairs (VA) EDs.
A pre-implementation survey assessed existing geriatric ED processes. In the pilot called SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services), sites identified high-risk patients during an ED visit. After ED discharge, Intermediate Care Technicians (ICTs, former military medics), performed follow-up telephone, or home visits. During the follow-up visit, ICTs identified "what matters," performed geriatric screens aligned with Age-Friendly Health Systems, observed home safety risks, assisted with video telehealth check-ins with ED providers, and provided care coordination. SCOUTS visit data were recorded in the patient's electronic medical record using a standardized template.
DATA COLLECTION/EXTRACTION METHODS: Sites were surveyed via electronic form. Administrative pilot data extracted from VA Corporate Data Warehouse, May-October 2021.
Site surveys showed none of the EDs had a formalized way of identifying the 4 M "what matters." During the pilot, ICT performed 56 telephone and 247 home visits. All home visits included a telehealth visit with an ED provider (n = 244) or geriatrician (n = 3). ICTs identified 44 modifiable home fall risks and 99 unmet care needs, recommended 80 pieces of medical equipment, placed 36 specialty care consults, and connected 180 patients to a Patient Aligned Care Team member for follow-up.
A post-ED follow-up program in which former military medics perform geriatric screens and care coordination is feasible. Combining telehealth and home visits allows providers to address what matters and unmet care needs.
通过由远程医疗支持的急诊科（ED）随访上门访视，描述一项针对老年人的可行性试点研究，该研究旨在解决数字鸿沟、未满足的医疗保健需求以及老年友善健康系统的“4M”问题。
资料来源为美国退伍军人事务部（VA）六家 ED 预实施现场调查和试点阶段的个体患者数据。
预实施调查评估了现有的老年 ED 流程。在名为 SCOUTS（支持社区门诊、紧急护理和远程医疗服务）的试点中，各站点在 ED 就诊期间确定高危患者。ED 出院后，中级护理技术员（ICT，前军事医务人员）进行电话或上门随访。在随访期间，ICT 确定“重要事项”，进行与老年友善健康系统一致的老年筛查，观察家庭安全风险，协助 ED 医生进行视频远程健康检查，并提供护理协调。SCOUTS 访视数据使用标准化模板记录在患者的电子病历中。
资料收集/提取方法：通过电子表格对站点进行调查。2021 年 5 月至 10 月，从 VA 企业数据仓库中提取行政试点数据。
站点调查显示，没有一个 ED 有一个正式的方法来识别 4M“重要事项”。在试点期间，ICT 进行了 56 次电话访视和 247 次上门访视。所有上门访视都包括与 ED 医生（n=244）或老年病医生（n=3）进行远程医疗访视。ICT 确定了 44 个可修改的家庭跌倒风险和 99 个未满足的护理需求，推荐了 80 件医疗设备，安排了 36 次专科咨询，并将 180 名患者与患者护理团队成员联系以进行后续护理。
由前军事医务人员进行老年筛查和护理协调的 ED 后随访计划是可行的。远程医疗和上门访视相结合，使医务人员能够解决重要问题和未满足的护理需求。
