Angela G Catic1, Melissa L P Mattison2, Innokentiy Bakaev3, Marisa Morgan4, Sara M Monti5, Lewis Lipsitz6. 1. Department of Medicine and Section of Geriatrics, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston TX. Electronic address: acatic@bcm.edu. 2. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mmattison@bidmc.harvard.edu. 3. Lawrence General Hospital, Lawrence, MA; Greater Lawrence Family Health Center, Lawrence, MA; Elder Services Plan of the North Shore, Lynn, MA. 4. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 5. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA. 6. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA; Hebrew SeniorLife Institute for Aging Research, Boston, MA.
Abstract
OBJECTIVES: To design, implement, and assess the pilot phase of an innovative, remote case-based video-consultation program called ECHO-AGE that links experts in the management of behavior disorders in patients with dementia to nursing home care providers. DESIGN: Pilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes. SETTING: Eleven long-term care sites in Massachusetts and Maine. PARTICIPANTS: An interprofessional specialty team at a tertiary care center and staff from 11 long-term care sites. INTERVENTION: Long-term care sites presented challenging cases regarding residents with dementia and/or delirium related behavioral issues to specialists via video-conferencing. METHODS: Baseline resident characteristics and follow-up data regarding compliance with ECHO-AGE recommendations, resident improvement, hospitalization, and mortality were collected from the long-term care sites. RESULTS: Forty-seven residents, with a mean age of 82 years, were presented during the ECHO-AGE pilot period. Eighty-three percent of residents had a history of dementia and 44% were taking antipsychotic medications. The most common reasons for presentation were agitation, intrusiveness, and paranoia. Behavioral plans were recommended in 72.3% of patients. Suggestions for medication adjustments were also frequent. ECHO-AGE recommendations were completely or partially followed in 88.6% of residents. When recommendations were followed, sites were much more likely to report clinical improvement (74% vs 20%, P < .03). Hospitalization was also less common among residents for whom recommendations were followed. CONCLUSIONS: The results suggest that a case-based video-consultation program can be successful in improving the care of elders with dementia and/or delirium related behavioral issues by linking specialists with long-term care providers. Published by Elsevier Inc.
OBJECTIVES: To design, implement, and assess the pilot phase of an innovative, remote case-based video-consultation program called ECHO-AGE that links experts in the management of behavior disorders in patients with dementia to nursing home care providers. DESIGN: Pilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes. SETTING: Eleven long-term care sites in Massachusetts and Maine. PARTICIPANTS: An interprofessional specialty team at a tertiary care center and staff from 11 long-term care sites. INTERVENTION: Long-term care sites presented challenging cases regarding residents with dementia and/or delirium related behavioral issues to specialists via video-conferencing. METHODS: Baseline resident characteristics and follow-up data regarding compliance with ECHO-AGE recommendations, resident improvement, hospitalization, and mortality were collected from the long-term care sites. RESULTS: Forty-seven residents, with a mean age of 82 years, were presented during the ECHO-AGE pilot period. Eighty-three percent of residents had a history of dementia and 44% were taking antipsychotic medications. The most common reasons for presentation were agitation, intrusiveness, and paranoia. Behavioral plans were recommended in 72.3% of patients. Suggestions for medication adjustments were also frequent. ECHO-AGE recommendations were completely or partially followed in 88.6% of residents. When recommendations were followed, sites were much more likely to report clinical improvement (74% vs 20%, P < .03). Hospitalization was also less common among residents for whom recommendations were followed. CONCLUSIONS: The results suggest that a case-based video-consultation program can be successful in improving the care of elders with dementia and/or delirium related behavioral issues by linking specialists with long-term care providers. Published by Elsevier Inc.
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