Title

Impact of Telemedicine on Mortality, Length of Stay, and Cost among Patients in Progressive Care Units: Experience from a Large Healthcare System

Abstract

Utilizing a retrospective observational study design, this study aimed to determine whether telemedicine intervention can affect hospital mortality, length of stay, and direct costs for progressive care unit patients. Adult patients admitted to progressive care unit (PCU) as their primary admission in a large health care system between December 2011 and August 2016 (n = 16091). During the study period, PCU patients with telemedicine intervention (TPCU, n = 8091) and nontelemedicine (NTPCU, n = 8000) were compared concurrently. Primary outcome was PCU and hospital mortality. Secondary outcomes were hospital length of stay, PCU length of stay, and mean direct costs. The mean age NTPCU and TPCU patients were 63.4 years (95%CI, 62.9-63.8 yr) and 71.1 years (95% CI, 70.7-71.74 yr), respectively. All Patient Refined-Diagnosis Related Group Disease Severity (p<.0001) and All Patient Refined-Diagnosis Related Group Patient Risk of Mortality (p<.0001) sources were significantly higher among TPCU versus NTPCU. After adjusting for age, sex, race, disease severity, risk of mortality, hospital entity, and organ systems, TPCU survival benefit was 20%. Mean progressive care unit length of stay was lower among TPCU compared with NTPCU (2.6 vs 3.2 d; p < 0.0001). Postprogressive care unit hospital length of stay was longer for TPCU patients, compared with NTPCU (7.3 vs 6.8 d; p < 0.0001). The overall mean direct cost was higher for TPCU ($13,180), compared with NTPCU ($12,301; p < 0.0001). In conclusion, although there are many studies about the effects of telemedicine in ICU, currently there are no studies on the effects of telemedicine in progressive care unit settings. Our study showed that TPCU intervention significantly decreased mortality in progressive care unit and hospital and progressive care unit length of stay despite the fact patients in TPCU were older and had higher disease severity, and risk of mortality. Increased postprogressive care unit hospital length of stay and total mean direct costs inclusive of telemedicine costs coincided with improved survival rates. Telemedicine intervention decreased overall mortality and length of stay within progressive care units without substantial cost incurrences.

Publication Date

10-25-2019

Presented At:

14th Annual BHSF Research Conference

Content Type

Poster Presentation

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