Emergency Medical Technician-Facilitated Telehealth Visits: A New Model to Expand Home-Based Primary Care for Homebound Seniors
Keywords:Emergency Medical Technician, Home-Based Primary Care, Homebound, Mobile Telemedicine Technician, Physician Extender, Telehealth, Telemedicine
Objective: As the number of older adults living in the United States grows, the gap between the capacity of home-based primary care (HBPC) services and the community demand will continue to widen. Older adults, living longer with mobility difficulties and multiple chronic medical conditions, often prefer to age in place, and new models of care are needed to meet this need. This article provides a framework for an innovative emergency medical technician (EMT)-facilitated telehealth program, the mobile telemedicine technician (MTT) program, which aims to increase access to medical care and efficiency within an HBPC program.
Design: A descriptive framework outlining the deployment of an innovative telehealth model.
Setting: An HBPC program serving homebound seniors in downstate New York.
Participants: Homebound individuals enrolled in an HBPC program with advanced age (over half >90 years), 67% with 5–6 activities of daily living (ADL) dependencies, and high rates of dementia, congestive heart failure, chronic obstructive pulmonary disease (COPD), and diabetes requiring evaluation and treatment of acute conditions.
Interventions: HBPC program enrollees requiring evaluation and treatment of acute conditions received a home visit from a telehealth-enabled EMT who has received additional training to provide in-home care. Following an evaluation, the EMT facilitated a telehealth visit via a two-way video conference between the patient and the primary care physician.
Main outcome measures: Description of a novel telehealth care model, preliminary results from the first 100 MTT visits including the reason for visit, patient/caregiver, physician, and telehealth-enabled EMT satisfaction survey results.
Results: The primary care provider was able to evaluate twice as many patients in a given time period using the new model as in the regular home visit care model. The most common visit reasons were related to skin conditions (22%), neurological conditions (19%), cardiovascular conditions (16%), and respiratory conditions (15%). Satisfaction rates were high from patients/caregivers (45% response rate, 60% strongly agreed and 29% agreed that they were satisfied with the care delivery experience), physician (six surveys over time from one physician, 100% strongly agreed on the effectiveness of care delivery model), and telehealth-enabled EMTs (eight surveys from four EMTs, 100% strongly agreed that they were satisfied with the care delivery experience).
Conclusions: In this descriptive article, we outline a new model of care using telehealth-enabled EMTs making home visits to connect with a patient’s primary care physician who is centrally located. This model shows promise for expanding primary care services within the home.
Ornstein KA, Leff B, Covinsky KE, et al. Epidemiology of the homebound population in the United States. JAMA Intern Med. 2015;175(7):1180–6. https://doi.org/10.1001/jamainternmed.2015.1849
Mather M, Kilduff L, Scommegna P. Fact sheet: Aging in the United States [Internet]. Population Reference Bureau; 2019 [cited 2020 Apr 8]. Available from: https://www.prb.org/aging-unitedstates-fact-sheet/.
West LA, Cole S, Goodkind D, He W. 65 in the United States: 2010 special studies current population reports [Internet]. US Dept of Health and Human Services, US Dept of Commerce; 2014 [cited 2020 Apr 8]. Available from: https://www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf.
Soones T, Federman A, Leff B, Siu AL, Ornstein K. Two-year mortality in homebound older adults: An analysis of the National Health and Aging Trends Study. J Am Geriatr Soc. 2016;65(1):123–9. https://doi.org/10.1111/jgs.14467
Abrashkin KA, Poku A, Ramjit A, et al. Community paramedics treat high acuity conditions in the home: A prospective observational study. BMJ Support Palliat Care. 2019. https://doi.org/10.1136/bmjspcare-2018-001746
Stall N, Nowaczynski M, Sinha SK. Systematic review of outcomes from home-based primary care programs for homebound older adults. J Am Geriatr Soc. 2014;62(12):2243–51. https://doi.org/10.1111/jgs.13088
Edes T, Kinosian B, Vuckovic NH, Nichols LO, Becker MM, Hossain M. Better access, quality, and cost for clinically complex veterans with home-based primary care. J Am Geriatr Soc. 2014;62(10):1954–61. https://doi.org/10.1111/jgs.13030
Yao N, Ritchie C, Camacho F, Leff B. Geographic concentration of home-based medical care providers. Health Affairs. 2016;35(8):1404–9. https://doi.org/10.1377/hlthaff.2015.1437
Langabeer JR, Champagne-Langabeer T, Alqusairi D, et al. Cost-benefit analysis of telehealth in pre-hospital care. J Telemed Telecare. 2016;23(8):747–51. https://doi.org/10.1177/1357633X16680541
Majors-Foley K. Telemedicine in prehospital stroke evaluation and thrombolysis: Taking stroke treatment to the doorstep. J Emerg Med. 2016;51(1):93–4. https://doi.org/10.1016/j.jemermed.2016.06.024
Winburn AS, Brixey JJ, Langabeer J, Champagne-Langabeer T. A systematic review of prehospital telehealth utilization. J Telemed Telecare. 2017;24(7):473–81. https://doi.org/10.1177/1357633X17713140
Champagne-Langabeer T, Langabeer JR, Roberts KE, et al. Telehealth impact on primary care related ambulance transports. Prehosp Emerg Care. 2019;23(5):712–7. https://doi.org/10.1080/10903127.2019.1568650
Dang S, Olsan T, Karuza J, et al. Telehealth in home-based primary care: Factors and challenges associated with integration into veteran care. J Am Geriatr Soc. 2019;67(9):1928–33. https://doi.org/10.1111/jgs.16045
Latus-Olaifa O, Norman GJ, Kurliand M, et al. Not yet ready for prime time: Video visits in a home-based primary care program. J Am Geriatr Soc. 2019;67(10):2202–4. https://doi.org/10.1111/jgs.16064
De Cola MCD, Maresca G, D’Aleo G, et al. Teleassistance for frail elderly people: A usability and customer satisfaction study. Geriatr Nurs. 2020. https://doi.org/10.1016/j.gerinurse.2020.01.019
How to Cite
Authors retain copyright of their work, with first publication rights granted to Telehealth and Medicine Today (TMT).
TMT is published under a Creative Commons Attribution-NonCommercial 4.0 International License.