| Autor: |
Hamilton T; Department of Telemedicine and Virtual Rehabilitation, Burke Medical Research Institute, White Plains, New York., Johnson L; Stroke Department, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia., Quinn BT; Department of Telemedicine and Virtual Rehabilitation, Burke Medical Research Institute, White Plains, New York., Coppola J; Westchester Public/Private Partnership for Aging Services, White Plains, New York.; Seidenberg School of Computer Science and Information Systems, Pace University, Pleasantville, New York., Sachs D; Westchester Public/Private Partnership for Aging Services, White Plains, New York.; Seidenberg School of Computer Science and Information Systems, Pace University, Pleasantville, New York., Migliaccio J; Westchester Public/Private Partnership for Aging Services, White Plains, New York., Phipps C; Westchester Public/Private Partnership for Aging Services, White Plains, New York.; Department of Senior Program and Services, The Westchester County Department of Senior Programs and Services, White Plains, New York., Schwartz J; Westchester Public/Private Partnership for Aging Services, White Plains, New York.; Department of Senior Program and Services, The Westchester County Department of Senior Programs and Services, White Plains, New York., Capasso M; Westchester Public/Private Partnership for Aging Services, White Plains, New York.; Department of Senior Program and Services, The Westchester County Department of Senior Programs and Services, White Plains, New York., Carpenter M; Westchester Public/Private Partnership for Aging Services, White Plains, New York.; Department of Senior Program and Services, The Westchester County Department of Senior Programs and Services, White Plains, New York., Putrino D; Department of Telemedicine and Virtual Rehabilitation, Burke Medical Research Institute, White Plains, New York.; Westchester Public/Private Partnership for Aging Services, White Plains, New York.; Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, Manhattan, New York. |
| Abstrakt: |
Background: Chronic disease in older adults is estimated to account for 84% of annual health care spending in the United States, with many preventable costs expected to rise as the population continues to age. Introduction: Telehealth Intervention Programs for Seniors (TIPS) is a community-embedded program targeting low-income older adults, providing weekly assessment of vital signs and subjective wellness, and wrap-around aging services. Materials and Methods: TIPS recruited 765 volunteers over 55 years, who were Medicaid and/or Medicare eligible. Data were collected from 2014 to 2016 [median enrollment 343 days (105-435)] using 12 TIPS sites. This observational study evaluated the efficacy of TIPS by measuring within-subject changes in self-reported hospital visits and <30-day readmissions, before and during TIPS participation. Data of 617 participants (median age 74.3; interquartile range 16) were analyzed. Results: Self-reported hospital visits were reduced by 28.9% ( p = 0.0013). Medicare participants benefited the most, with a 50% ( p < 0.0001) reduction in hospital visits, and a 75.5% ( p = 0.017) reduction in <30-day readmissions. Multivariate analysis revealed that participants (1) Medicaid-registered (odds ratio [OR] = 2.72, 95% confidence interval [CI] 0.392-1.611), (2) reporting feeling unwell (OR = 1.33, 95% CI 0.118-0.459), and (3) living alone (OR = 2.34, 95% CI 0.115-1.592) were significantly more likely than other participants to experience a hospital visit. Discussion: TIPS demonstrates that community-embedded health services can reduce rates of hospital visits in older adults. Conclusion: The success of TIPS highlights the potential of successfully deployed remote patient-monitoring initiatives in reducing the utilization of costly health services. |
