Getting the right specialty care to patients in rural areas has historically posed major challenges for the healthcare industry.
However, a new study published by the Open Forum Infectious Diseases found that when hospitals tapped infectious disease specialists via an electronic, asynchronous tool, patients fared better and had fewer hospital readmissions than their counterparts that did not have the service.
“Numerous studies have demonstrated that infectious diseases (ID) consultation is associated with improved outcomes for hospitalized patients,” the authors of the study wrote. “However, the supply of ID specialists may not meet the current or anticipated demand. Smaller hospitals may not have the demand needed to justify the sustained presence of dedicated on-site ID specialists."
Researchers reported a 70% reduction in 30-day mortality for patients who had ID eConsultations compared to the controls (p < .01).
Six of the 100 patients in the study group were readmitted to the hospital within 30 days, whereas 33 of the 300 patients in the control group were readmitted (p = .07). On average, the length of stay was longer for patients in the study group compared to the control group (5.7 days versus 3.8 days; p < .01).
The control group also saw a slightly higher, but not significant rate of hospital transfers — 10% in the study group versus 6.3% in the control group (p = .50). However, the rate of cases transferred for care related to infection was similar (4%) for the study group and in the control group (4.7%).
HOW IT WAS DONE
In the study, ID specialists from the Mayo Clinic Health Rochester (Mayo’s flagship campus) provided their services through an asynchronous, virtual consultation to two rural hospitals, the Mayo Clinic Health System Austin Hospital and Mayo Clinic Health System Albert Lea Hospital.
Providers at the rural hospitals could request a consultation. Then specialists from MCHR would take a look at the EHR and provide notes. If needed, the ID specialist could speak to the referring provider electronically or through the telephone.
Researchers matched up 300 controls to 100 cases in the study group. The average age of study group participants was 69.7 years, and was made up of 55% women.
Rural health has been a major focus of telemedicine efforts in recent years with startups, hospital systems and government agencies evaluating the new tools.
The US Department of Agriculture announced new grant investments in late November for infrastructure aimed at expanding education and healthcare access among rural US residents. The full bundle consists of 133 grants totaling $42.5 million, and are spread across 37 states and two US territories.
Additionally, the Federal Communications Commission has spent the last couple of years pushing forward a $100 million initiative that would provide a major discount to providers establishing broadband-based telehealth programs, with rural care as a major priority.
However, telehealth adoption in rural areas has been slow, according to some reports. In 2018 the USDA found that rural residents were actually less likely than their urban counterparts to partake in online health research, maintenance and monitoring services.
“In summary, asynchronous ID eConsultation is a viable option for hospitals without in-person ID consultation,” authors of the study wrote. “ID eConsultation is associated with a decrease in 30-day mortality, no increase in hospital-to-hospital transfer, and a high level of satisfaction from referring providers.”