<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03832257</url>
  </required_header>
  <id_info>
    <org_study_id>2018P000457</org_study_id>
    <nct_id>NCT03832257</nct_id>
  </id_info>
  <brief_title>Improving Safety of Transitions to Skilled Nursing Care Using Videoconferencing</brief_title>
  <acronym>ECHO-CT</acronym>
  <official_title>AHRQ Health Services Research Projects: Making Health Care Safer in Ambulatory Care Settings and Long Term Care Facilities</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Beth Israel Deaconess Medical Center</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Brown University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Hebrew SeniorLife</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Beth Israel Deaconess Medical Center</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      This prospective cohort study seeks to determine if the ECHO-CT program, a healthcare&#xD;
      videoconferencing program, can improve clinical outcomes while reducing cost and resource&#xD;
      utilization when expanded to a community hospital setting. Data will be analyzed on the&#xD;
      facility level and patient level.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      ECHO-Care Transitions is a healthcare outreach program utilizing videoconferencing technology&#xD;
      to improve the quality and efficiency of care transitions for medically-complex elderly&#xD;
      patients by connecting post-acute care facilities that receive BIDMC patients with a&#xD;
      multidisciplinary BIDMC team that sends these patients following discharge. This case-control&#xD;
      study seeks to determine if ECHO-CT can improve clinical outcomes and reduce cost and&#xD;
      resource utilization during transitions of care in both an academic (BIDMC Boston) and&#xD;
      community (BIDMC Needham) hospital.&#xD;
&#xD;
      Our prospective cohort study of the ECHO-CT intervention will take place in the two&#xD;
      Boston-area hospitals, one providing tertiary care and one community-based care, in which the&#xD;
      outcomes of patients transferred to Skilled Nursing Facilities (SNFs) associated with these&#xD;
      hospitals will be compared to those transferred to SNFs from similar hospitals in New&#xD;
      England. We will also be comparing outcomes from individual patients enrolled in the ECHO&#xD;
      program to matched controls. Using a national database available from the Brown University&#xD;
      Center for Gerontology and Healthcare Research, the outcomes of Medicare beneficiaries&#xD;
      residing in SNFs that are participating in ECHO-CT will be compared to those in the&#xD;
      comparison group using a difference-of-difference analytic approach. Analyses will be&#xD;
      adjusted for potential confounders as appropriate.&#xD;
&#xD;
      In this study, the investigators also plan to measure satisfaction as well as process,&#xD;
      utilization, cost and patient safety outcomes to determine best practices for implementing&#xD;
      the program at a community hospital and affiliated SNFs.&#xD;
&#xD;
      Data will be obtained from the following sources:&#xD;
&#xD;
        1. Protected health information (PHI) from resident assessment data, as well as Medicare&#xD;
           claims and enrollment data to be obtained via a data use agreement (DUA) with the&#xD;
           Centers for Medicare and Medicaid Services (CMS) by the Brown University Center for&#xD;
           Gerontology and Health Care Research during years 2-3 of the study to include the&#xD;
           following:&#xD;
&#xD;
             1. The resident Minimum Data Set Resident Assessment (MDS) assessments. The MDS has&#xD;
                nearly 400 data elements including cognitive function, communication/hearing&#xD;
                problems, physical functioning, continence, psycho-social well-being, mood state,&#xD;
                activity and recreation, diagnoses, health conditions, nutritional status,&#xD;
                oral/dental status, skin conditions, special treatments, and medication use. The&#xD;
                assessments are done for all patients admitted to Medicare and Medicaid certified&#xD;
                SNFs, including enrollees in both traditional Medicare and Medicare Advantage.&#xD;
                These data will already be housed at Brown University,Brown has an active DUA to&#xD;
                obtain quarterly pulls of the population of MDS assessments .&#xD;
&#xD;
             2. Medicare claims which will be used to ascertain 30-day costs, re-hospitalizations,&#xD;
                and use of other medical services by Medicare fee for service (FFS) patients&#xD;
                admitted to the SNFs. The data also include diagnosis fields to ascertain&#xD;
                comorbidities.&#xD;
&#xD;
             3. Medicare enrollment file includes demographic information such as sex and race,&#xD;
                dates of birth and death, and various indicators of Medicare/Medicaid eligibility,&#xD;
                Part D eligibility, and Medicare Advantage enrollment.&#xD;
&#xD;
             4. BIDMC will collect and share ECHO-CT participating patient's social security number&#xD;
                and health insurance claims number with Brown University. Their clinical&#xD;
                information will be matched with control patients from the Medicare claims data to&#xD;
                show study effect on 30-day costs, re-hospitalizations rate and patient length of&#xD;
                stay.&#xD;
&#xD;
        2. In addition to aggregates derived from above, facility level data will come from the&#xD;
           Certification and Survey Provider Enhanced Reporting (CASPER) data, which are publicly&#xD;
           available and based upon facility surveys for Medicare/Medicaid certification. They will&#xD;
           be used in addition to data from &quot;Nursing Home Compare and the Long Term Care: Facts on&#xD;
           Care in the US (LTCFocus.org) websites to describe the SNFs.&#xD;
&#xD;
        3. Intervention-specific data: Project-specific quality improvement data derived from&#xD;
           questionnaires, staff satisfaction surveys, and structured meeting minutes will be&#xD;
           designed and evaluated by BIDMC and Hebrew Senior Life&#xD;
&#xD;
             1. SNF Satisfaction: Every 6 months the investigators will send a satisfaction&#xD;
                questionnaire to the hospitals and SNFs participating in ECHO-CT to assess their&#xD;
                views of the ECHO-CT sessions, the value of time spent, feelings of empowerment,&#xD;
                inter-professional relationships, learning, and recommendations. All answers to the&#xD;
                survey questions will be kept strictly confidential. This information will be used&#xD;
                to improve the content and organization of the sessions and to develop tools for&#xD;
                dissemination (Aim 3). The investigators will develop the satisfaction&#xD;
                questionnaire during the first 6 months of the project, building upon our previous&#xD;
                survey experience and literature review. Metrics to quantify the quality of&#xD;
                transitional care will be derived from the work of Coleman et al.3 and incorporated&#xD;
                into the questionnaire. Survey design and evaluation will be conducted by the&#xD;
                outcome evaluation group under the leadership of Dr. Thomas Travison at Hebrew&#xD;
                SeniorLife's Institute for Aging Research.&#xD;
&#xD;
             2. Process assessment: The investigators will keep attendance logs to assess adherence&#xD;
                to the ECHO-CT intervention and its changes over time. Any consistent decline in&#xD;
                staff attendance for 2 or more weeks will be followed up by phone calls to assess&#xD;
                barriers to participation and corrective actions will be taken. These may include&#xD;
                changing to a more convenient time, identifying other providers who can attend&#xD;
                instead, contacting facility administrators or medical directors for their support,&#xD;
                and providing incentive gifts or continuing education credits In addition, during&#xD;
                each ECHO-CT session, the hospital based team will inquire about unexpected&#xD;
                outcomes or issues that arose during the transition process, including those&#xD;
                related to patients already discussed. This element will allow for an ongoing&#xD;
                technology-enabled learning platform and continuous quality improvement mechanism&#xD;
                over the course of the proposed project. The value of the video-conferencing&#xD;
                approach is that it creates a mutually trusting learning community in which &quot;all&#xD;
                teach and all learn.&quot;&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Active, not recruiting</overall_status>
  <start_date type="Actual">September 30, 2018</start_date>
  <completion_date type="Anticipated">August 31, 2023</completion_date>
  <primary_completion_date type="Anticipated">August 31, 2023</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Non-Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Health Services Research</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>30-Day Readmission Rates</measure>
    <time_frame>30-Days</time_frame>
    <description>Number of hospital readmissions over 30 day period among participating SNF sites</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Health Care Utilization</measure>
    <time_frame>up to 90 days</time_frame>
    <description>Includes average length of stay in the facility</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Health Care Cost</measure>
    <time_frame>30-days</time_frame>
    <description>Total 30-day Medicare costs for fee-for-service patients.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">800</enrollment>
  <condition>Acute Disease</condition>
  <arm_group>
    <arm_group_label>ECHO CT Intervention</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Weekly video conference between hospitalist at Beth Israel and skilled nursing facilities.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Matched Non- Participating Facilities</arm_group_label>
    <arm_group_type>Other</arm_group_type>
    <description>Matched non-participating facilities</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>ECHO CT Intervention</intervention_name>
    <description>weekly video conference between hospitalist and skilled nursing facilities</description>
    <arm_group_label>ECHO CT Intervention</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Matched Non-Participating Facilities</intervention_name>
    <description>Matched Non-Participating Facilities</description>
    <arm_group_label>Matched Non- Participating Facilities</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Facility Inclusion Criteria:&#xD;
&#xD;
          -  SNF receives approximately the middle third of referral volume (approx. 20-100&#xD;
             referrals/ average 40 per year)&#xD;
&#xD;
          -  SNF not so highly engaged with acute hospital that their patients are less likely to&#xD;
             benefit from the intervention.&#xD;
&#xD;
          -  SNF affiliated with BIDMC Boston or BIDMC Needham&#xD;
&#xD;
        Facility Exclusion Criteria:&#xD;
&#xD;
          -  Has not recently participated in ECHO CT&#xD;
&#xD;
          -  Do not send anyone to ECHO CT training&#xD;
&#xD;
          -  Clinicians are unwilling to make a commitment to attend at least 75% of video&#xD;
             conferences&#xD;
&#xD;
        Patient Selection:&#xD;
&#xD;
        ECHO-CT Group:&#xD;
&#xD;
        Inclusion Criteria: Patients that were discharged from BIDMC and admitted to skilled&#xD;
        nursing facilities that are participating in ECHO-CT between April 2019 and March 2021.&#xD;
&#xD;
        Exclusion Criteria: Patients discharged from a hospital other than BIDMC. Patients admitted&#xD;
        to a skilled nursing facility that is not participating in ECHO-CT.&#xD;
&#xD;
        Control Group:&#xD;
&#xD;
        Inclusion Criteria: Patients from skilled nursing facilities not participating in ECHO.&#xD;
&#xD;
        Exclusion Criteria: Patients discharged from BIDMC to one of our participating SNFs during&#xD;
        the study period of April 2019- March 2021&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>65 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>Beth Israel Deaconess Medical Center</name>
      <address>
        <city>Boston</city>
        <state>Massachusetts</state>
        <zip>02215</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Arora S, Thornton K, Jenkusky SM, Parish B, Scaletti JV. Project ECHO: linking university specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in New Mexico. Public Health Rep. 2007;122 Suppl 2(Suppl 2):74-7. doi: 10.1177/00333549071220S214.</citation>
    <PMID>17542458</PMID>
  </reference>
  <reference>
    <citation>Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, Parish B, Burke T, Pak W, Dunkelberg J, Kistin M, Brown J, Jenkusky S, Komaromy M, Qualls C. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011 Jun 9;364(23):2199-207. doi: 10.1056/NEJMoa1009370. Epub 2011 Jun 1.</citation>
    <PMID>21631316</PMID>
  </reference>
  <reference>
    <citation>Boltz M, Parke B, Shuluk J, Capezuti E, Galvin JE. Care of the older adult in the emergency department: nurses views of the pressing issues. Gerontologist. 2013 Jun;53(3):441-53. doi: 10.1093/geront/gnt004. Epub 2013 Feb 26.</citation>
    <PMID>23442380</PMID>
  </reference>
  <reference>
    <citation>Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med. 2004 Oct 5;141(7):533-6. doi: 10.7326/0003-4819-141-7-200410050-00009.</citation>
    <PMID>15466770</PMID>
  </reference>
  <reference>
    <citation>Kessler C, Williams MC, Moustoukas JN, Pappas C. Transitions of care for the geriatric patient in the emergency department. Clin Geriatr Med. 2013 Feb;29(1):49-69. doi: 10.1016/j.cger.2012.10.005.</citation>
    <PMID>23177600</PMID>
  </reference>
  <reference>
    <citation>Moore AB, Krupp JE, Dufour AB, Sircar M, Travison TG, Abrams A, Farris G, Mattison MLP, Lipsitz LA. Improving Transitions to Postacute Care for Elderly Patients Using a Novel Video-Conferencing Program: ECHO-Care Transitions. Am J Med. 2017 Oct;130(10):1199-1204. doi: 10.1016/j.amjmed.2017.04.041. Epub 2017 May 25.</citation>
    <PMID>28551043</PMID>
  </reference>
  <reference>
    <citation>Marks C, Loehrer S, McCarthy D. Hospital readmissions: measuring for improvement, accountability, and patients. Issue Brief (Commonw Fund). 2013 Sep;24:1-8.</citation>
    <PMID>24044140</PMID>
  </reference>
  <reference>
    <citation>Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood). 2010 Jan-Feb;29(1):57-64. doi: 10.1377/hlthaff.2009.0629.</citation>
    <PMID>20048361</PMID>
  </reference>
  <reference>
    <citation>LaMantia MA, Scheunemann LP, Viera AJ, Busby-Whitehead J, Hanson LC. Interventions to improve transitional care between nursing homes and hospitals: a systematic review. J Am Geriatr Soc. 2010 Apr;58(4):777-82. doi: 10.1111/j.1532-5415.2010.02776.x.</citation>
    <PMID>20398162</PMID>
  </reference>
  <reference>
    <citation>Austin BJ. Rehospitalization from skilled nursing facilities: implications for policy. Find Brief. 2010 Feb;12(9):1-3.</citation>
    <PMID>20222212</PMID>
  </reference>
  <reference>
    <citation>Ouslander JG, Diaz S, Hain D, Tappen R. Frequency and diagnoses associated with 7- and 30-day readmission of skilled nursing facility patients to a nonteaching community hospital. J Am Med Dir Assoc. 2011 Mar;12(3):195-203. doi: 10.1016/j.jamda.2010.02.015. Epub 2010 Aug 12.</citation>
    <PMID>21333921</PMID>
  </reference>
  <verification_date>December 2022</verification_date>
  <study_first_submitted>February 3, 2019</study_first_submitted>
  <study_first_submitted_qc>February 4, 2019</study_first_submitted_qc>
  <study_first_posted type="Actual">February 6, 2019</study_first_posted>
  <last_update_submitted>December 14, 2022</last_update_submitted>
  <last_update_submitted_qc>December 14, 2022</last_update_submitted_qc>
  <last_update_posted type="Actual">December 16, 2022</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Beth Israel Deaconess Medical Center</investigator_affiliation>
    <investigator_full_name>Lewis Lipsitz</investigator_full_name>
    <investigator_title>Professor of Medicine</investigator_title>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Acute Disease</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03832257
org study id: 2018P000457
nct id: NCT03832257
lead sponsor: 
collaborator: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
This prospective cohort study seeks to determine if the ECHO-CT program, a healthcare
      videoconferencing program, can improve clinical outcomes while reducing cost and resource
      utilization when expanded to a community hospital setting. Data will be analyzed on the
      facility level and patient level.
ECHO-Care Transitions is a healthcare outreach program utilizing videoconferencing technology
      to improve the quality and efficiency of care transitions for medically-complex elderly
      patients by connecting post-acute care facilities that receive BIDMC patients with a
      multidisciplinary BIDMC team that sends these patients following discharge. This case-control
      study seeks to determine if ECHO-CT can improve clinical outcomes and reduce cost and
      resource utilization during transitions of care in both an academic (BIDMC Boston) and
      community (BIDMC Needham) hospital.

      Our prospective cohort study of the ECHO-CT intervention will take place in the two
      Boston-area hospitals, one providing tertiary care and one community-based care, in which the
      outcomes of patients transferred to Skilled Nursing Facilities (SNFs) associated with these
      hospitals will be compared to those transferred to SNFs from similar hospitals in New
      England. We will also be comparing outcomes from individual patients enrolled in the ECHO
      program to matched controls. Using a national database available from the Brown University
      Center for Gerontology and Healthcare Research, the outcomes of Medicare beneficiaries
      residing in SNFs that are participating in ECHO-CT will be compared to those in the
      comparison group using a difference-of-difference analytic approach. Analyses will be
      adjusted for potential confounders as appropriate.

      In this study, the investigators also plan to measure satisfaction as well as process,
      utilization, cost and patient safety outcomes to determine best practices for implementing
      the program at a community hospital and affiliated SNFs.

      Data will be obtained from the following sources:

        1. Protected health information (PHI) from resident assessment data, as well as Medicare
           claims and enrollment data to be obtained via a data use agreement (DUA) with the
           Centers for Medicare and Medicaid Services (CMS) by the Brown University Center for
           Gerontology and Health Care Research during years 2-3 of the study to include the
           following:

             1. The resident Minimum Data Set Resident Assessment (MDS) assessments. The MDS has
                nearly 400 data elements including cognitive function, communication/hearing
                problems, physical functioning, continence, psycho-social well-being, mood state,
                activity and recreation, diagnoses, health conditions, nutritional status,
                oral/dental status, skin conditions, special treatments, and medication use. The
                assessments are done for all patients admitted to Medicare and Medicaid certified
                SNFs, including enrollees in both traditional Medicare and Medicare Advantage.
                These data will already be housed at Brown University,Brown has an active DUA to
                obtain quarterly pulls of the population of MDS assessments .

             2. Medicare claims which will be used to ascertain 30-day costs, re-hospitalizations,
                and use of other medical services by Medicare fee for service (FFS) patients
                admitted to the SNFs. The data also include diagnosis fields to ascertain
                comorbidities.

             3. Medicare enrollment file includes demographic information such as sex and race,
                dates of birth and death, and various indicators of Medicare/Medicaid eligibility,
                Part D eligibility, and Medicare Advantage enrollment.

             4. BIDMC will collect and share ECHO-CT participating patient's social security number
                and health insurance claims number with Brown University. Their clinical
                information will be matched with control patients from the Medicare claims data to
                show study effect on 30-day costs, re-hospitalizations rate and patient length of
                stay.

        2. In addition to aggregates derived from above, facility level data will come from the
           Certification and Survey Provider Enhanced Reporting (CASPER) data, which are publicly
           available and based upon facility surveys for Medicare/Medicaid certification. They will
           be used in addition to data from "Nursing Home Compare and the Long Term Care: Facts on
           Care in the US (LTCFocus.org) websites to describe the SNFs.

        3. Intervention-specific data: Project-specific quality improvement data derived from
           questionnaires, staff satisfaction surveys, and structured meeting minutes will be
           designed and evaluated by BIDMC and Hebrew Senior Life

             1. SNF Satisfaction: Every 6 months the investigators will send a satisfaction
                questionnaire to the hospitals and SNFs participating in ECHO-CT to assess their
                views of the ECHO-CT sessions, the value of time spent, feelings of empowerment,
                inter-professional relationships, learning, and recommendations. All answers to the
                survey questions will be kept strictly confidential. This information will be used
                to improve the content and organization of the sessions and to develop tools for
                dissemination (Aim 3). The investigators will develop the satisfaction
                questionnaire during the first 6 months of the project, building upon our previous
                survey experience and literature review. Metrics to quantify the quality of
                transitional care will be derived from the work of Coleman et al.3 and incorporated
                into the questionnaire. Survey design and evaluation will be conducted by the
                outcome evaluation group under the leadership of Dr. Thomas Travison at Hebrew
                SeniorLife's Institute for Aging Research.

             2. Process assessment: The investigators will keep attendance logs to assess adherence
                to the ECHO-CT intervention and its changes over time. Any consistent decline in
                staff attendance for 2 or more weeks will be followed up by phone calls to assess
                barriers to participation and corrective actions will be taken. These may include
                changing to a more convenient time, identifying other providers who can attend
                instead, contacting facility administrators or medical directors for their support,
                and providing incentive gifts or continuing education credits In addition, during
                each ECHO-CT session, the hospital based team will inquire about unexpected
                outcomes or issues that arose during the transition process, including those
                related to patients already discussed. This element will allow for an ongoing
                technology-enabled learning platform and continuous quality improvement mechanism
                over the course of the proposed project. The value of the video-conferencing
                approach is that it creates a mutually trusting learning community in which "all
                teach and all learn."
allocation: Non-Randomized
intervention model: Parallel Assignment
primary purpose: Health Services Research
masking: None (Open Label)
measure: 30-Day Readmission Rates
time frame: 30-Days
description: Number of hospital readmissions over 30 day period among participating SNF sites
measure: Health Care Utilization
time frame: up to 90 days
description: Includes average length of stay in the facility
measure: Health Care Cost
time frame: 30-days
description: Total 30-day Medicare costs for fee-for-service patients.
arm group label: ECHO CT Intervention
arm group type: Experimental
description: Weekly video conference between hospitalist at Beth Israel and skilled nursing facilities.
arm group label: Matched Non- Participating Facilities
arm group type: Other
description: Matched non-participating facilities
intervention type: Other
intervention name: ECHO CT Intervention
description: weekly video conference between hospitalist and skilled nursing facilities
arm group label: ECHO CT Intervention
intervention type: Other
intervention name: Matched Non-Participating Facilities
description: Matched Non-Participating Facilities
arm group label: Matched Non- Participating Facilities
criteria: 
gender: All
minimum age: 65 Years
maximum age: N/A
healthy volunteers: No
facility: 
country: United States
citation: Arora S, Thornton K, Jenkusky SM, Parish B, Scaletti JV. Project ECHO: linking university specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in New Mexico. Public Health Rep. 2007;122 Suppl 2(Suppl 2):74-7. doi: 10.1177/00333549071220S214.
PMID: 17542458
citation: Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, Parish B, Burke T, Pak W, Dunkelberg J, Kistin M, Brown J, Jenkusky S, Komaromy M, Qualls C. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011 Jun 9;364(23):2199-207. doi: 10.1056/NEJMoa1009370. Epub 2011 Jun 1.
PMID: 21631316
citation: Boltz M, Parke B, Shuluk J, Capezuti E, Galvin JE. Care of the older adult in the emergency department: nurses views of the pressing issues. Gerontologist. 2013 Jun;53(3):441-53. doi: 10.1093/geront/gnt004. Epub 2013 Feb 26.
PMID: 23442380
citation: Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med. 2004 Oct 5;141(7):533-6. doi: 10.7326/0003-4819-141-7-200410050-00009.
PMID: 15466770
citation: Kessler C, Williams MC, Moustoukas JN, Pappas C. Transitions of care for the geriatric patient in the emergency department. Clin Geriatr Med. 2013 Feb;29(1):49-69. doi: 10.1016/j.cger.2012.10.005.
PMID: 23177600
citation: Moore AB, Krupp JE, Dufour AB, Sircar M, Travison TG, Abrams A, Farris G, Mattison MLP, Lipsitz LA. Improving Transitions to Postacute Care for Elderly Patients Using a Novel Video-Conferencing Program: ECHO-Care Transitions. Am J Med. 2017 Oct;130(10):1199-1204. doi: 10.1016/j.amjmed.2017.04.041. Epub 2017 May 25.
PMID: 28551043
citation: Marks C, Loehrer S, McCarthy D. Hospital readmissions: measuring for improvement, accountability, and patients. Issue Brief (Commonw Fund). 2013 Sep;24:1-8.
PMID: 24044140
citation: Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood). 2010 Jan-Feb;29(1):57-64. doi: 10.1377/hlthaff.2009.0629.
PMID: 20048361
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PMID: 21333921
responsible party type: Principal Investigator
investigator affiliation: Beth Israel Deaconess Medical Center
investigator full name: Lewis Lipsitz
investigator title: Professor of Medicine
mesh term: Acute Disease
sharing ipd: No