Improving Transitions to Post-acute Care for Elderly Patients Using a Novel Video-Conferencing Program: ECHO- Care Transitions

• Published in: The American journal of medicine
• Main Authors: Moore, Amber B., MD, MPH, Krupp, J. Elyse, MPH, Dufour, Alyssa B., PhD, Sircar, Mousumi, MD, Travison, Thomas G., PhD, Abrams, Alan, MD, Farris, Grace, MD, Mattison, Melissa L.P., MD, Lipsitz, Lewis A., MD
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Internal Medicine; ECHO; care transitions; readmissions
• ISSN: 0002-9343
• DOI: 10.1016/j.amjmed.2017.04.041

Abstract Purpose Within 30 days of hospital discharge to a skilled nursing facility, older adults are at high risk for death, re-hospitalization and high-cost healthcare. The purpose of this study was to examine whether a novel videoconference program called Extension for Community Health Outcomes-Care Transitions (ECHO-CT) that connects an interdisciplinary hospital-based team with clinicians at skilled nursing facilities, reduces patient mortality, hospital readmission, skilled nursing facility length of stay and 30-day health care costs. Methods A prospective cohort study comparing cost and health care utilization outcomes between ECHO-CT facilities and matched comparisons from January 2014-December 2014. Results 30-day readmission rates were significantly lower in the intervention group (OR 0.57; 95% CI 0.34 – 0.96; p-value 0.04) as was the 30-day total healthcare cost ($2,602.19 lower; 95% CI -$4,133.90- -$1,070.48; p-value <.001) and the average length of stay at the skilled nursing facility (-5.52 days; 95% CI -9.61- -1.43; p=0.001). The 30-day mortality rate was not significantly lower in the intervention group (OR 0.38; 95% CI 0.11-1.24; p=0.11). Conclusion Patients discharged to skilled nursing facilities participating in the ECHO-CT program had shorter lengths of stay, lower 30-day rehospitalization rates, and lower 30-day health care costs compared to those in matched skilled nursing facilities delivering usual care. ECHO-CT may improve patient transitions to post-acute care at lower overall cost.