Evaluating Tele-Emergency Care in Costs and Outcomes for Rural Sepsis Patients

Study Overview
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Brief Summary
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Sepsis is a life-threatening emergency for which provider-to-provider telemedicine has been used to improve quality of care. The objective of this study is to measure the impact of rural tele-emergency consultation on long-term health care costs and outcomes through decreasing organ failure, hospital length-of-stay, and readmissions.

Detailed Description
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Sepsis is responsible for over 1.7 million hospitalizations at a cost of $26 billion annually, making it the most expensive acute care condition in US hospitals. High-quality early sepsis care has been associated with decreased organ failure, shorter ICU and hospital length-of-stay, and improved survival. Rural sepsis patients are more likely to be transferred to tertiary centers, and they also have higher mortality and health care costs. ED-based telemedicine (tele-ED) consultation between a rural provider and a board-certified emergency physician may deliver the expertise to reduce care delays and improve outcomes while avoiding unnecessary costs. In 2017, the study team partnered with Avera eCARE, the largest tele-ED provider in North America, to implement a standard telemedicine-based sepsis care pathway. Subsequently, the investigators showed (using patient-level primary data collection across several networks) that tele-ED use was associated with improved adherence with international sepsis guidelines. In addition to its association with short-term clinical outcomes, however, the study team hypothesize that telemedicine may also decrease costs. The investigators have shown that high-quality sepsis care is associated with decreased readmissions and post-discharge mortality. High quality care may also prevent organ failure, avoid ICU admissions, reduce mechanical ventilation and vasopressor use, decrease ICU and hospital length-of-stay, and decrease post-discharge care-primarily through reducing avoidable organ failure. All of these factors are likely to have a significant effect in terms of reducing healthcare cost. The objective of the proposed project is to measure the effect of tele-ED consultation at reducing healthcare costs and long-term outcomes in sepsis patients in rural EDs. The following primary hypotheses will be tested: Total healthcare expenses and 90-day mortality will be lower in patients treated in a tele-ED hospital, with the effect primarily through reduced hospital length-of-stay and fewer readmissions. Total expenses and mortality will be lower in cases where tele-ED is used vs. matched controls in non-tele-ED hospitals.

Official Title
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Evaluating the Role of Tele-Emergency Care in Health Care Costs and Long-Term Outcomes for Rural Medicare Beneficiaries With Sepsis

Conditions
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Sepsis

Intervention / Treatment
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* Other: Telemedicine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Sepsis, according to ICD-10 codes Exclusion Criteria: No infection diagnosed in the ED

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Non-tele-ED hospital<br>Patients receiving care in an ED that does not provide any tele-ED service | |
| Tele-ED hospital<br>Patients receiving care in an ED that uses tele-ED services, but patient care did NOT utilize this service | |
| Tele-ED used<br>Patient care was provided through tele-ED services | Other: Telemedicine<br>* Receiving care in a tele-ED hospital<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total healthcare expenditures | Defined as direct inpatient and outpatient payments to hospitals and physicians, skilled nursing care, home care, durable medical equipment, and ambulance costs from the ED visit until 30 days post-discharge. Drugs are not included. | From hospital admission until 30 days after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants who die within 90 days of hospital admission | 90-day mortality | From hospital admission until 90 days after admission | 
| Hospital length-of-stay | Duration of hospitalization | From date of hospitalization through hospital discharge, assessed up to 90 days | 
| Number of participants requiring ICU care | Any admission to the ICU | From the date of hospital admission through hospital discharge or 90 days, whichever comes first, the number of participants who are treated in an intensive care unit | 
| Emergency department costs | Total healthcare expenditures related to emergency department care in current hospitalization | From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all emergency department health care expenditures | 
| Inpatient care costs | Total healthcare expenditures related to inpatient care in current hospitalizations | From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all inpatient health care expenditures | 
| Inter-hospital transfer costs | Emergency medical services transfer costs and second emergency department costs (if transferred) | From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all inter-hospital transfer health care expenditures | 
| Post-discharge costs | Total healthcare expenditures | From the date of hospital discharge through 30 days after discharge, total health care expenditures health care expenditures | 
| Readmission costs | Total healthcare expenditures during readmission(s) within 30 days after initial hospital discharge | Between hospital discharge and 30 days after hospital discharge, related to inpatient re-hospitalization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Telemedicine