Author, date and journal | Study design | Sample and setting | Research focus | Relevant results | Wider implications | Limitations |
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Hex et al.; 2018; Economic analysis of care homes: New Models of Care Vanguard [36] | 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 [37] | 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 [39] | 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 [57] | 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 [58] | 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. |