This pre-post study will evaluate the implementation of a cardiovascular telehealth platform, which will connect experts from the Wake Forest University Health Sciences (WFUHS) tertiary care center with Wilkes County Emergency Medical Services (WC-EMS) system, Wilkes Medical Center Emergency Department (ED), and The Wilkes County Health Department Public Health Community Clinic (PHCC) to improve cardiovascular care in this rural community.
This program aims to improve cardiovascular care for patients in Wilkes County by implementing a cardiovascular telehealth program designed to; a) assist WC- EMS paramedics with the early risk stratification (electrocardiogram (EKG) interpretation, vital signs, and risk scores), treatment, and transportation destination decisions in patients with acute chest pain or dyspnea, b) support Wilkes Medical Center (WMC) Emergency Department (ED) providers (physicians and advanced practice clinicians) in the evaluation, management, and disposition of patients with acute cardiovascular symptoms, and c) provide consultative expertise to the Primary Health Care Centers (PHCC) for patients seen following an EMS or ED encounter for cardiovascular symptoms.
Study Type
OBSERVATIONAL
Enrollment
215
Data will be retrospectively collected through EHR queries
Wilkes County Emergency Medical Services
Wilkesboro, North Carolina, United States
Wilkes County Public Health Community Clinic
Wilkesboro, North Carolina, United States
Wilkes Medical Center
Wilkesboro, North Carolina, United States
Wake Forest University Health Sciences
Winston-Salem, North Carolina, United States
Number of Emergency Department (ED) utilization
ED utilization among patients with cardiovascular symptoms will be defined as the total number of cardiovascular-related ED admissions divided by the total number of unique individual patients receiving cardiovascular care during the project period.
Time frame: baseline
Number of Cardiovascular hospitalizations
Cardiovascular hospitalizations will be defined as an inpatient or observation admission for cardiovascular conditions or symptoms based on Current Procedures Terminology (CPT) and International Classification of Diseases (ICD) codes
Time frame: Baseline
Number of Cardiovascular Inter-facility transfers
Cardiovascular Inter-facility transfers will be defined based on patients with cardiovascular symptoms or conditions transferred from Wilkes Medical Center (WMC) to another hospital.
Time frame: Baseline
Number of 30-day cardiovascular Emergency Department (ED) re-admissions
30-day cardiovascular ED re-admissions will be defined as any cardiovascular related ED admission occurring during the 30 days following their initial/index ED encounter.
Time frame: day 30
Number of 30-day cardiovascular hospital re-admissions
30-day cardiovascular hospital re-admissions will be defined as any cardiovascular related hospital admission occurring during the 30 days following their index hospitalization.
Time frame: day 30
Number of Adverse Events
Determine if telehealth implementation will result in improved sorting of cases for escalated and de-escalated care, reducing the number of adverse events.
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Time frame: day 30 and Month 12
Change in Cost - societal level
Evaluate whether spending on healthcare (i.e., insurance payments) changes during the 30-day follow-up period.
Time frame: day 30 and Month 12
Change in Cost - provider level
Estimates will be obtained for the impact of the establishment of the telehealth program on the budget of the tertiary center.
Time frame: day 30 and Month 12
Cost-effectiveness
Cost-effectiveness: will be evaluated at the societal level to inform the relative changes in patient outcomes and costs resulting from the telehealth program.
Time frame: Month 12 and Month 48
Cardiovascular telehealth consultation rate
Cardiovascular telehealth consultation rate will be assessed by identifying the total number of patients that received cardiovascular telehealth consultations at each originating site divided by the total number of patients at each originating site with cardiovascular symptoms.
Time frame: Baseline
Cardiovascular telehealth adoption rate
Adoption rate will be defined by the cardiovascular telehealth consultation rate at each originating site during the first 12 months following implementation of the cardiovascular telehealth service.
Time frame: Month 12
Cardiovascular telehealth sustainability rate
Sustainability rate will be defined by the cardiovascular telehealth consultation rate at each site greater than 12 months after the availability of the cardiovascular telehealth service.
Time frame: Month 24 - Month 48 post Intervention