Enhancing Rural Health Via Cardiovascular Telehealth for Rural Patients Implementation (E-VICTORS)

Study Overview
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Brief Summary
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This pre-post study will evaluate the implementation of a cardiovascular telehealth platform, which will connect experts from the Wake Forest University Health Sciences (WFUHS) tertiary care center with Wilkes County Emergency Medical Services (WC-EMS) system, Wilkes Medical Center Emergency Department (ED), and The Wilkes County Health Department Public Health Community Clinic (PHCC) to improve cardiovascular care in this rural community.

Detailed Description
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This program aims to improve cardiovascular care for patients in Wilkes County by implementing a cardiovascular telehealth program designed to; a) assist WC- EMS paramedics with the early risk stratification (electrocardiogram (EKG) interpretation, vital signs, and risk scores), treatment, and transportation destination decisions in patients with acute chest pain or dyspnea, b) support Wilkes Medical Center (WMC) Emergency Department (ED) providers (physicians and advanced practice clinicians) in the evaluation, management, and disposition of patients with acute cardiovascular symptoms, and c) provide consultative expertise to the Primary Health Care Centers (PHCC) for patients seen following an EMS or ED encounter for cardiovascular symptoms.

Official Title
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Enhancing Rural Health Via Cardiovascular Telehealth for Rural Patients (E-VICTORS) Project

Conditions
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Cardiovascular Diseases, Acute Coronary Syndrome

Intervention / Treatment
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* Other: Quality Surveillance Data Collection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age > 18 years at time of index encounter Cardiovascular symptoms (chest discomfort or dyspnea consistent with possible ACS) as indicated by the treating provider Exclusion Criteria: Age <18 Traumatic chest pain Dyspnea that is clearly from a non-cardiac etiology Patients with hemodynamic instability SBP < 90 mmHg, HR>160 or <40 bpm Patients requiring intubation/mechanical ventilation

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 |
| --- | --- |
| Quality Surveillance Data<br>For this quality surveillance study, data will be collected retrospectively through electronic health record (EHR) queries for all eligible patients treated for acute cardiovascular symptoms by one of the study sites. | Other: Quality Surveillance Data Collection<br>* Data will be retrospectively collected through EHR queries<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Emergency Department (ED) utilization | ED utilization among patients with cardiovascular symptoms will be defined as the total number of cardiovascular-related ED admissions divided by the total number of unique individual patients receiving cardiovascular care during the project period. | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Cardiovascular hospitalizations | Cardiovascular hospitalizations will be defined as an inpatient or observation admission for cardiovascular conditions or symptoms based on Current Procedures Terminology (CPT) and International Classification of Diseases (ICD) codes | Baseline | 
| Number of Cardiovascular Inter-facility transfers | Cardiovascular Inter-facility transfers will be defined based on patients with cardiovascular symptoms or conditions transferred from Wilkes Medical Center (WMC) to another hospital. | Baseline | 
| Number of 30-day cardiovascular Emergency Department (ED) re-admissions | 30-day cardiovascular ED re-admissions will be defined as any cardiovascular related ED admission occurring during the 30 days following their initial/index ED encounter. | day 30 | 
| Number of 30-day cardiovascular hospital re-admissions | 30-day cardiovascular hospital re-admissions will be defined as any cardiovascular related hospital admission occurring during the 30 days following their index hospitalization. | day 30 | 
| Number of Adverse Events | Determine if telehealth implementation will result in improved sorting of cases for escalated and de-escalated care, reducing the number of adverse events. | day 30 and Month 12 | 
| Change in Cost - societal level | Evaluate whether spending on healthcare (i.e., insurance payments) changes during the 30-day follow-up period. | day 30 and Month 12 | 
| Change in Cost - provider level | Estimates will be obtained for the impact of the establishment of the telehealth program on the budget of the tertiary center. | day 30 and Month 12 | 
| Cost-effectiveness | Cost-effectiveness: will be evaluated at the societal level to inform the relative changes in patient outcomes and costs resulting from the telehealth program. | Month 12 and Month 48 | 
| Cardiovascular telehealth consultation rate | Cardiovascular telehealth consultation rate will be assessed by identifying the total number of patients that received cardiovascular telehealth consultations at each originating site divided by the total number of patients at each originating site with cardiovascular symptoms. | Baseline | 
| Cardiovascular telehealth adoption rate | Adoption rate will be defined by the cardiovascular telehealth consultation rate at each originating site during the first 12 months following implementation of the cardiovascular telehealth service. | Month 12 | 
| Cardiovascular telehealth sustainability rate | Sustainability rate will be defined by the cardiovascular telehealth consultation rate at each site greater than 12 months after the availability of the cardiovascular telehealth service. | Month 24 - Month 48 post Intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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acute chest pain, telehealth, implementation science, rural health