SD eResidential Facilities Healthcare Services Access Project

Evidence-level

Promising (About evidence-level criteria)

Description

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 clinical needs of their residents, most with multiple chronic health problems.

Time becomes of concern for providers traveling from clinic to clinic over long distances in order to treat a resident with an urgent or complex health issue.

Additionally for long-term care residents themselves, transferring out of their home environment to another setting with other providers causes discomfort and disorientation that further complicates their condition.

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 2012 project was originally based on practice models and studies of eLongTerm Care (eLTC) endorsed by the American Telemedicine Association. The intent of the eLTC program was to assist rural long-term care facilities with better 24-hour access to needed care and urgent care support. Staff training and education and other geriatric services were also included.

Avera and its partners implemented the project at 20 sites located in South Dakota, Iowa, Minnesota, and Nebraska. Participant facilities in this program were chosen by criteria which included rural status, healthcare access needs, urgent care needs, and nursing support needs.

The original project's population included frail elders in long-term care, assisted living, and rehabilitation facilities since elderly residents have higher rates of mortality associated with chronic diseases, such as diabetes, heart disease, and Alzheimer's Disease. At the time, project site residents were also noted to be older than state and 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 close-up details, and other peripheral equipment, the eResidential project kept residents in their own facility with the caregivers who know them best and who were best able to provide their care. Project services also provided site staff and caregivers with specialized sources of medical information.

The eLTC strategies decreased healthcare cost by avoiding unnecessary emergency room visits and hospital readmissions.

The consortium partners of the SD eResidential Facilities Healthcare Services Access Project included:

• 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.

Services offered

Initial services during the grant-funded activities included:

• Access to a provider 24 hours, 7 days a week, 365 days per year via two-way video for rural residential facilities and residents
• e-Specialty access include Infectious Disease, Wound Care, Cardiology, Nephrology, and more
• ePharmacy services offering information on drug administration, side effects, and interactions
• Evaluation of long-term care residents' complications and complaints
• Emergency assistance if needed through eER (eEmergency Room)
• Enhanced resources available to long-term care staff

Results

During the original 3-year grant cycle, there were over 630 two-way video encounters in addition to almost 800 consults not requiring the patient to be on camera. By the 3rd year, 63% of potential transfers were avoided due to collaborative efforts between the teams.

At present, the program responds to approximately 5000 encounters per month at an average of 150 participating facilities per month. About 90% of urgent encounters result in treatments delivered in the long-term care facility, avoiding innumerable transfers for acute evaluation.

Additionally, education is provided on the topics of behavioral health, wound care, head-to-toe assessments, advance care planning, and pharmacy interventions.

Challenges

Challenges associated in the original grant cycle were:

• Inconsistent primary care providers for facility residents
• Sites' distance barrier from the eLTC Hub for training and support services
• Differing provider credentialing requirements between sites — which now are solved by utilization of eEmergency physicians to cover sites while credentialing issues reconciled

Replication

• Universal staff training
• Full leadership support to direct how eLTC services utilized
• Preservation of wireless mobility

Contact Information

Anthony Erickson, Vice President of Senior Services
Avera Sacred Heart Hospital
605.668.8920
aerickson@avera.org