Telemedicine vs face-to-face for nursing home residents with acute presentations : a noninferiority study

G.Y. Huang, M. Kumar, X. Liu, D. Irwanto, Y. Zhou, E. Chirapa, Y.H. Xu, B. Shulruf, Daniel K.Y. Chan

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Objectives: Telemedicine and face-to-face outreach services to nursing homes (NHs) have been used to reduce hospital utilization rates for acute presentations. However, how these modalities compare against each other is unclear. This article examines if the management of acute presentations in NHs with care involving telemedicine is noninferior to care delivered face-to-face. Design: A noninferiority study was conducted on a prospective cohort. Face-to-face intervention involved on-site assessment by a geriatrician and aged care clinical nurse specialist (CNS). Telemedicine intervention involved on-site assessment by an aged care CNS with telemedicine input by a geriatrician. Setting and Participants: A total of 438 NH residents with acute presentations from 17 NHs between November 2021 and June 2022. Methods: Between-group differences in proportion of residents successfully managed on-site and mean number of encounters were evaluated using bootstrapped multiple linear regression; 95% CIs were compared against predefined noninferiority margins with noninferiority P values calculated. Results: In the adjusted models, care involving telemedicine demonstrated noninferiority in the difference in proportion of residents successfully managed on-site (95% CI lower limit −6.2% to −1.4% vs −10% noninferiority margin; P <.001 for noninferiority) but not in the difference in mean number of encounters (95% CI upper limit 1.42 to 1.50 encounters vs 1 encounter noninferiority margin; P =.7 for noninferiority). Conclusions and Implications: In our model of care, care that involved telemedicine was noninferior to care delivered face-to-face in managing NH residents with acute presentations on-site. However, additional encounters may be required. Application of telemedicine ought to be tailored to fit the needs and preferences of stakeholders.

Original languageEnglish
Pages (from-to)1471-1477
Number of pages7
JournalJournal of the American Medical Directors Association
Volume24
Issue number10
DOIs
Publication statusPublished - Oct 2023

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