Acute Coronary Syndrome, Cardiovascular Diseases
Conditions
Keywords
acute chest pain, telehealth, implementation science, rural health
Brief summary
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.
Detailed description
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.
Interventions
OTHERQuality Surveillance Data Collection
Data will be retrospectively collected through EHR queries
Sponsors
Wake Forest University Health Sciences
Health Resources and Services Administration (HRSA)
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age \> 18 years at time of index encounter * Cardiovascular symptoms (chest discomfort or dyspnea consistent with possible ACS) as indicated by the treating provider
Exclusion criteria
* Age \<18 * Traumatic chest pain * Dyspnea that is clearly from a non-cardiac etiology * Patients with hemodynamic instability SBP \< 90 mmHg, HR\>160 or \<40 bpm * Patients requiring intubation/mechanical ventilation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Emergency Department (ED) utilization | baseline | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Cardiovascular hospitalizations | Baseline | 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 |
| Number of Cardiovascular Inter-facility transfers | Baseline | Cardiovascular Inter-facility transfers will be defined based on patients with cardiovascular symptoms or conditions transferred from Wilkes Medical Center (WMC) to another hospital. |
| Number of 30-day cardiovascular Emergency Department (ED) re-admissions | day 30 | 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. |
| Number of 30-day cardiovascular hospital re-admissions | day 30 | 30-day cardiovascular hospital re-admissions will be defined as any cardiovascular related hospital admission occurring during the 30 days following their index hospitalization. |
| Number of Adverse Events | day 30 and Month 12 | Determine if telehealth implementation will result in improved sorting of cases for escalated and de-escalated care, reducing the number of adverse events. |
| Change in Cost - societal level | day 30 and Month 12 | Evaluate whether spending on healthcare (i.e., insurance payments) changes during the 30-day follow-up period. |
| Change in Cost - provider level | day 30 and Month 12 | Estimates will be obtained for the impact of the establishment of the telehealth program on the budget of the tertiary center. |
| Cost-effectiveness | Month 12 and Month 48 | Cost-effectiveness: will be evaluated at the societal level to inform the relative changes in patient outcomes and costs resulting from the telehealth program. |
| Cardiovascular telehealth consultation rate | Baseline | 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. |
| Cardiovascular telehealth adoption rate | Month 12 | 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. |
| Cardiovascular telehealth sustainability rate | Month 24 - Month 48 post Intervention | 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. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORSimon A Mahler, MD, MS
Wake Forest University Health Sciences
Outcome results
None listed