Effectiveness and Organizational Conditions of Effectiveness of Telemedicine in Establishments Providing Care for the Dependent Elderly

Study Overview
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Brief Summary
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Study of interest of Telemedicine in establishments providing care for the dependent elderly (EHPAD in french) is a strategy for improving the course of care of residents, including the number not programmed hospitalizations, and a multidimensional analysis of the conditions of effectiveness of telemedicine will identify the keys to optimize its use.

Detailed Description
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The project combines quantitative and qualitative analyses : 1. Quantitative study Study of comparative prospective cohort clustered in two parallel groups: Group 'Telemedicine': establishments providing care for the dependent elderly (EHPAD in french) equipped for telemedicine (teleconsultation, casualty) as part of the regional project of the Aquitaine Regional Agency of Heath telemedicine device deployment. Control group: Defined and equipped for telemedicine EHPAD after matching on the number of residents, the GMP (average weighted GIR : Groupes Iso Ressources = score to reflects the average level of dependency of residents of a residential care facility for the elderly), the PMP (weighted average PATHOS = an evaluation system set up by the National Union of Clinical Gerontology and the Medical Service of the National Fund for Health Insurance for Salaried Workers), the distance to a hospital with an emergency shelter service. The rate of unscheduled hospitalizations will be collected during follow-up visits in clinical departments of the healthcare of the Gironde (french department) by a research staff. 2 Qualitative study In the Group of nursing homes with telemedicine, said group Telemedicine, will be identified four long-term care facilities, selected according to their degree of use of telemedicine (ratio number of teleconsultation per month / number of beds) (EHPAD 2 strong users, 2 nursing homes) low users) within these four long-term care facilities will be carried out observations of field and in-depth interviews with professionals, managers and attending physicians.

Official Title
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Effectiveness and Organizational Conditions of Effectiveness of Telemedicine in Establishments Providing Care for the Dependent Elderly

Conditions
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Health Services for the Aged

Intervention / Treatment
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* Procedure: Evaluation of disease and follow-up


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Quantitative research: All residents of nursing home men and women 65 years of age and more and likely to be eligible for a teleconsultation or a casualty because achieved one of the identified chronic pathologies as a reason for teleconsultation, will be included in both groups of long-term care Medical professionals working in the nursing home agreeing to answer the specifics questionnaires Qualitative study: Doctors, physicians and coordinators nurses of Establishments Providing Care for the Dependent Elderly, nurses, orderly, psychologists, directors of Establishments Having a professional activity in nursing homes selected Having given their consent to participate in the study Exclusion Criteria: Residents of long-term care facilities (quantitative study) Resident (or guardian/person) who expressed his opposition to participate in the study or not likely to be eligible for a teleconsultation or casualty Establishments Providing Care for the Dependent Elderly (qualitative) professionals Professional who expressed his opposition to participate in the study

Ages Eligible for Study
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Minimum Age: 65 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 |
| --- | --- |
| Establishments with telemedicine system<br>Establishments equipped for telemedicine (teleconsultation, casualty) as part of the regional project of the Aquitaine regional program telemedicine device deployment. | Procedure: Evaluation of disease and follow-up<br>* Correspondence medical consultation with specific device<br>* Other names: Telemedicine;|
| Establishments without telemedicine system<br>Defined and equipped for telemedicine EHPAD after mating on the number of residents, the GMP (average weighted GIR), the PMP (weighted average PATHOS), the distance to a hospital with an emergency shelter service. The rate of unscheduled hospitalizations will be collected during follow-up visits in clinical departments of the healthcare of the Gironde by a research staff | Procedure: Evaluation of disease and follow-up<br>* Correspondence medical consultation with specific device<br>* Other names: Telemedicine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of hospitalization not programmed residents on Medicine Surgery obstetrics (MCO) | Number of hospitalizations not programmed residents on Medicine Surgery obstetrics (MCO) between the inclusion and 12 month | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the main diagnosis, coded by the International Classification of diseases for every hospitalization | Evaluate the number of inappropriate hospitalization. The inappropriate hospitalization will be performed using the classification of Weissman. Weissman classification identifies causes of potentially preventable hospitalizations, from the main diagnosis, coded by the International Classification of diseases, version 10 (ICD10). | 12 months | 
| Score of the specific questionnaire for measurement of the context organizational and Managerial in health care facilities | Evaluate the impact of a strategy issued in EHPAD type teleconsultation or casualty on the quality of work life | 12 months |