Impact of an Intensive Care Unit Telemedicine Program on Patient Outcomes in an Integrated Health Care System
Open accessAbstract
IMPORTANCE: Intensive care unit (ICU) telemedicine (TM) programs have been promoted as improving access to intensive care specialists and ultimately improving patient outcomes, but data on effectiveness are limited and conflicting. OBJECTIVE: To examine the impact of ICU TM on mortality rates and length of stay (LOS) in an integrated health care system. DESIGN, SETTING, AND PARTICIPANTS: Observational pre-post study of patients treated in 8 "intervention" ICUs (7 hospitals within the US Department of Veterans Affairs health care system) during 2011-2012 that implemented TM monitoring during the post-TM period as well as patients treated in concurrent control ICUs that did not implement an ICU TM program. INTERVENTION: Implementation of ICU TM monitoring. MAIN OUTCOMES AND MEASURES: Unadjusted and risk-adjusted ICU, in-hospital, and 30-day mortality rates and ICU and hospital LOS for patients who did or did not receive treatment in ICUs equipped with TM monitoring. RESULTS: Our study included 3355 patients treated in our intervention ICUs (1708 in the pre-TM period and 1647 in the post-TM period) and 3584 treated in the control ICUs during the same period. Patient demographics and comorbid illnesses were similar in the intervention and control ICUs during the pre-TM and post-TM periods; however, predicted ICU mortality rates were modestly lower for admissions to the intervention ICUs compared with control ICUs in both the pre-TM (3.0% vs 3.6%; P = .02) and post-TM (2.8% vs 3.5%; P < .001) periods. Implementation of ICU TM was not associated with a significant decline in ICU, in-hospital, or 30-day mortality rates or LOS in unadjusted or adjusted analyses. For example, unadjusted ICU mortality in the pre-TM vs post-TM periods were 2.9% vs 2.8% (P = .89) for the intervention ICUs and 4.0% vs 3.4% (P = .31) for the control ICUs. Unadjusted 30-day mortality during the pre-TM vs post-TM periods were 7.7% vs 7.8% (P = .91) for the intervention ICUs and 12.0% vs 10.2% (P = .08) for the control ICUs. Evaluation of interaction terms comparing the magnitude of mortality rate change during the pre-TM and post-TM periods in the intervention and control ICUs failed to demonstrate a significant reduction in mortality rates or LOS. CONCLUSIONS AND RELEVANCE: We found no evidence that the implementation of ICU TM significantly reduced mortality rates or LOS.
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Impact evaluation of RAFT activities remains an unfinished business.
“Impact evaluation of the RAFT activities remains an “unfinished business” (40–43)”
From The RAFT Telemedicine Network: Lessons Learnt and Perspectives from a Decade of Educational and Clinical Services in Low- and Middle-Incomes Countries (2014) · cites this paper as [40]
The Discussion says that more study is needed to evaluate the impact of ICU telemedicine on outcomes beyond mortality and length of stay. That supports the general idea that impact evaluation remains unfinished, but the paper studies a VA ICU telemedicine program and does not address RAFT activities. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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Telemedizin in der Intensivmedizin
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Telemedizin: Chancen und Grenzen in der Intensivmedizin
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- Authors
- Nassar, B. S., Vaughan-Sarrazin, M. S., Jiang, L., Reisinger, H. S., Bonello, R., & Cram, P.
- Affiliations
- University of Iowa (US)
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa3Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City
- Iowa City VA Health Care System (US)
- University of Iowa Hospitals and Clinics (US)
- Minneapolis VA Health Care System (US)
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2014-07-01
- Volume
- 174
- Issue
- 7
- Pages
- 1160
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC13003558
- OpenAlex
- W2090373984
- Cited by
- 79
- References
- 24
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 10 · 2019: 10 · 2018: 9 · 2017: 9 · 2016: 11 · 2015: 9 · 2014: 1
- FWCI
- 9.95
- Type
- journal article
- Language
- en
- Open access
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs (I01 HX000261)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24AR062133, AR062133)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- intensive care monitoring, mortality, length of hospital stay, 30-day mortality, in-hospital mortality, integrated health system, veterans, remote patient monitoring, risk adjustment, hospital readmission
- MeSH terms
- Aged, Aged, 80 and over, Female, Hospitals, Veterans, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Mortality, Telemedicine, Delivery of Health Care, Integrated
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