SD eResidential Facilities Healthcare Services Access Project
- Need: To provide health services for rural, elderly populations in long-term care who are inaccessible due to their location within four Midwest states.
- Intervention: Implemented telemedicine services to reach patients at their respective sites.
- Results: The program resulted in 362 provider-determined avoidable transfers and hundreds of telehealth encounters that ultimately kept patients in the comfort and care of their primary care providers.
Promising (About evidence-level criteria)
Due to variables such as distance, weather, or lack of provider availability, rural long-term care facilities and their staff are challenged with meeting the needs of residents with chronic health problems. Time becomes a concern when specialized providers must travel from clinic to clinic in order to treat a resident with an urgent or complex health issue. Moreover, long-term care patients with chronic illnesses are vulnerable to discomfort and disorientation when transferred out of their home setting, further deteriorating their health.
To address this, Avera Sacred Heart Hospital, along with four Avera affiliates, and two consortium partners, developed the SD eResidential Facilities Healthcare Services Access Project. This project was developed using practice models and studies of eLongTerm Care (eLTC) endorsed by the American Telemedicine Association. Avera and its partners implemented the project at 20 sites located in South Dakota, Iowa, Minnesota, and Nebraska. Facilities were identified to participate in this program based on criteria including rural status, healthcare access needs, urgent care needs, and nursing support needs. The Intent of the eLTC program was to assist rural long-term care facilities with better access around the clock to healthcare, urgent care support, staff training and education, and other geriatric services.
Frail elders in long-term care, assisted living, and rehabilitation facilities comprised the target population for the project. The elderly residents were reported to have higher than state or national rates of mortality associated with chronic diseases, including diabetes, heart disease, and Alzheimer’s Disease. In addition, long-term care residents at the project sites were older in age than state or the national averages.
The eLTC program was gradually and systematically implemented over three years in order to assure quality services. Through the use of two-way video, a specialized stethoscope, a camera used for closer details of patients, and other peripheral equipment, the eResidential project kept residents in their own facility with the caregivers that know them best and provide the care that they need. Also, numerous specialized medical sources of information were offered to caregivers through these services, eLTC strategies decreased healthcare cost by avoiding unnecessary emergency room visits or hospital re-admissions.
The consortium partners of the SD eResidential Facilities Healthcare Services Access Project include:
- Evangelical Lutheran Good Samaritan Society
- Avera Health
- Avera Queen of Peace Hospital
- Avera Marshall Regional Medical Services
- Avera St. Luke’s Hospital
- Golden Living Corporation
The program received support from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant.
Avera Health also has a larger collection of services called Avera eCare. Through these services, Avera connects rural health care providers to specialists in more urban areas.
- Provided rural residential facilities and residents access to a provider 24 hours, 7 days a week, 365 days per year via two-way video
- Access to specialty services through eConsult including topics such as Infectious Disease, Wound Care, Cardiology, and Nephrology
- ePharmacy, which offered information about drug administration, side effects, and drug interactions
- eLTC services supported the long-term care facilities with a variety of resident complications and complaints.
- Enhanced resources available to long-term care staff.
- 639 two-way video encounters
- 362 provider-determined avoidable transfers
- 757 encounters that consisted of providers seeking consults via phone or video calls without having the patient on camera
- Resident video encounters that resulted in provider-determined avoidable transfers totaled 33% in year 1, 50% in year 2, and 63% in year 3.
- Emergency assistance if needed through eER (eEmergency Room)
- Inconsistent primary care providers for residents at facilities
- Distance of some sites from the eLTC Hub when it came to training and support services
- Credentialing of providers was required to take place at several sites, which held up care services. A solution to this barrier was to utilize eEmergency physicians to help cover in those sites while credentialing by-law were worked out.
- Training of all individuals involved needs to be all inclusive and consistent.
- Leadership should provide and portray full support of the program in order to direct how eLTC services will be utilized.
- In order to preserve wireless mobility, refrain from mounting telehealth units.
Anthony Erickson, Senior Services Executive Director
Avera Sacred Heart Hospital
Iowa, Minnesota, Nebraska, South Dakota
October 9, 2015
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.