|Author, date and journal||Study design||Sample and setting||Research focus||Relevant results||Wider implications||Limitations|
|Hex et al.; 2018; Economic analysis of care homes: New Models of Care Vanguard ||Longitudinal cohort study.||141 care homes that had a telemedicine programme were compared with 25 control care homes in the north of England.||To quantify the economic benefits generated by a telemedicine programme 1 year after implementation.||Emergency department admissions decreased in the care homes using telemedicine by 4% and increased in the control homes by 7%. Of the intervention homes, nursing homes saw a 13% decrease in emergency admission and residential homes saw a 6% increase. Low intervention home usage was associated with a 17% reduction in emergency admissions, whilst high usage of homes was associated with a 10% increase.||The findings were not statistically significant and can only be taken at face value.||
Limited control group.|
Extensive data cleaning was needed to produce useable data.
The intervention was rolled out over time so there was no universal start date.
|Grabowski et al.; 2014; Health Affairs ||Prospective observational study.||A chain of care homes in Massachusetts introduced telemedicine in 11 homes, covering weekday evenings and weekends.||To establish whether the lack of a physician’s presence at homes out of hours might contribute to inappropriate hospitalisations and whether switching to an on-call telemedicine physician could reduce inappropriate hospital admissions.||
Both intervention and control groups saw a decline in hospitalisations, of 9.7 and 5.3%, respectively.|
When looking at more and less engaged homes, a significant decline in hospitalisations (11.3%) was found at more engaged care homes.
|The findings suggest that nursing homes fully engaged in out-of-hours telemedicine could see a reduction in hospitalisations.||Small sample.|
|Lustbader et al.; 2017; Journal of Palliative Medicine ||Quantitative, retrospective, comparative analysis .||82 US Medicare Shared Savings Program accountable care organisation deceased patients compared with 596 patients receiving usual care between October 2014 and March 2016.||To evaluate the impact of a home-based palliative care programme within an accountable care organisation on cost and resource utilisation during the final 3 months of life.||
A 34% reduction in hospital admissions during the final month of life was observed in hospital-based palliative care-enrolled patients.|
Hospital-based palliative care was also linked with a reduction in emergency department visits per 1000 patients compared with standard care (878 vs. 1097).
|Hospital-based palliative care in an accountable care organisation is linked with significant cost savings and fewer hospital admissions.||Did not test for the individual benefits or drawbacks of a 24/7 telephone line in this setting.|
|Hoek et al.; 2017; BMC Medicine ||Two-armed, non-blinded randomised control trial.||74 Dutch home-dwelling palliative care cancer patients between May 2011 and January 2015. Patients were randomised to either an intervention group that received weekly teleconsultations or a control group that received standard care for 12 weeks.||To determine the effects of weekly teleconsultations on hospital admissions for palliative patients (secondary objective).||The was no significant difference in mean hospital admissions between the intervention and control groups (0.47 vs. 0.38, p = 0.60).||Suggests that weekly teleconsultations do not reduce hospital admissions for palliative patients.||
Some patients eligible for the trial were not approached due to clinical considerations, which may have caused selection bias.|
High attrition rate.
|Bakitas el; 2015; Journal of Clinical Oncology ||Two arm randomised study||207 patients with advanced cancer attending a National Cancer Institute Center, a Veterans Affairs Medical Centre and community outreach clinics were randomly assigned to early or late intervention.||
Intervention included an in-person palliative care consultation, telehealth nurse coaching sessions and monthly follow-up.|
Outcomes were quality of life, symptom impact, mood, one-year survival and resource use (hospital/intensive care days, emergency room visits and death location.
|Overall patient-reported outcomes were not statistically significant after enrolment or before death. Kaplan-Meier one-year survival rates were 63% in the early group and 48% in the delayed group (p = 0.038). Relative rates of early to delayed decedents’ resource use were similar for hospital days, intensive care days, emergency room visits and home deaths.||Early-entry participants’ patient-reported outcomes and resource use were not statistically different; however, their survival 1 year after enrolment was improved compared with those who began 3 months later||Heterogeneity and differences in unmeasured characteristics could limit practical application. Results reflect a New England population. Half of patients in the delayed group were referred for palliative care consultation ahead of time. Not all patients completed all interventions.|