Effectiveness and cost-effectiveness of a telemedicine programme for preventing unplanned hospitalisations of older adults living in nursing homes: the GERONTACCESS cluster randomized clinical trial

BMC Geriatrics

Research

Pierre-Marie Preux¹  Sandrine Luce¹  Kevin Zarca²  Maroua Mimouni²  Isabelle Durand-Zaleski²  Marie-Laure Laroche³  Isabelle Tovena³  Cécile Laubarie-Mouret⁴  Noelle Cardinaud⁴  Caroline Gayot⁵  Achille Tchalla⁶ 

[1]Centre d’Épidémiologie, de Bio Statistique Et de Méthodologie de La Recherche (CEBIMER), CHU de Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France

[2]DRCI-URC Eco Ile-de-France, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

[3]Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, E-Santé), Institut OMEGA HEALTH, Université de Limoges, Limoges, France

[4]Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, E-Santé), Institut OMEGA HEALTH, Université de Limoges, Limoges, France

[5]CHU de Limoges, Pôle HU Gérontologie Clinique, 2 Avenue Martin-Luther King, F-87042, Limoges, France

[6]Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, E-Santé), Institut OMEGA HEALTH, Université de Limoges, Limoges, France

[7]CHU de Limoges, Pôle HU Gérontologie Clinique, 2 Avenue Martin-Luther King, F-87042, Limoges, France

[8]Unité de Recherche Clinique Et d’Innovation (URCI) en Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France

[9]Laboratoire VieSanté - UR 24134 (Vieillissement, Fragilité, Prévention, E-Santé), Institut OMEGA HEALTH, Université de Limoges, Limoges, France

[10]CHU de Limoges, Pôle HU Gérontologie Clinique, 2 Avenue Martin-Luther King, F-87042, Limoges, France

[11]Unité de Recherche Clinique Et d’Innovation (URCI) en Gérontologie, CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France

[12]Geriatric Medicine, University of Limoges, CHU Limoges, Laboratoire VieSanté - UR 24134, Limoges, France

关键词: Nursing home;    Multimorbidity;    Telemedicine;    Telehealth;    Hospitalisation;    Hospital readmission;    Prevention;   

DOI  :  10.1186/s12877-022-03575-6

 received in 2022-06-08, accepted in 2022-11-01,  发布年份 2022

来源: Springer

【 摘 要 】

ObjectiveThe GERONTACCESS trial evaluated the utility and cost-effectiveness of a gerontological telemedicine (TLM) programme for preventing unplanned hospitalisation of residents living in nursing homes (NHs) in regions lacking medical facilities and/or qualified medical providers (“medical deserts”).DesignGERONTACCESS was a 12-month, multicentre, prospective cluster-randomised trial conducted in NHs. The intervention group underwent TLM assessments every 3 months. The control group received the usual care. In both groups, comprehensive on-site assessments were conducted at baseline and the final visit. Care requirements were documented throughout the study.Setting and participantsNH residents aged ≥ 60 years with multiple chronic diseases.MethodsThe study outcomes were the proportion of patients who experienced avoidable and unplanned hospitalisation, and the incremental cost savings per quality-adjusted life years from baseline to the 12-month follow-up.ResultsOf the 426 randomised participants (mean ± standard deviation age, 87.2 ± 7.6 years; 311 [73.0%] women), 23.4% in the intervention group and 32.5% in the control group experienced unplanned hospitalisation (odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.43 to 0.97; p = 0.034). Each avoided hospitalisation in the intervention group saved $US 3,846.Conclusions and implicationsThe results of GERONTACCESS revealed that our gerontological, preventative TLM program significantly reduced unplanned hospitalisations. This innovative intervention limited disease progression and promoted a healthy lifestyle among NH residents.Trial registrationClinicaltrials.gov, NCT02816177, registered June 28, 2016.

【 授权许可】

CC BY   
© The Author(s) 2022

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