• Amber B Moore, J Elyse Krupp, Alyssa B Dufour, Mousumi Sircar, Thomas G Travison, Alan Abrams, Grace Farris, MattisonMelissa L PMLPHarvard Medical School, Boston, Mass; Massachusetts General Hospital, Boston., and Lewis A Lipsitz.
• Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: abmoore@bidmc.harvard.edu.
• Am. J. Med. 2017 Oct 1; 130 (10): 1199-1204.

PurposeWithin 30 days of hospital discharge to a skilled nursing facility, older adults are at high risk for death, re-hospitalization, and high-cost health care. The purpose of this study was to examine whether a novel videoconference program called Extension for Community Health Outcomes-Care Transitions (ECHO-CT) that connects an interdisciplinary hospital-based team with clinicians at skilled nursing facilities reduces patient mortality, hospital readmission, skilled nursing facility length of stay, and 30-day health care costs.MethodsWe undertook a prospective cohort study comparing cost and health care utilization outcomes between ECHO-CT facilities and matched comparisons from January 2014-December 2014.ResultsThirty-day readmission rates were significantly lower in the intervention group (odds ratio 0.57; 95% CI, 0.34-0.96; P-value .04), as were the 30-day total health care cost ($2602.19 lower; 95% CI, -$4133.90 to -$1070.48; P-value <.001) and the average length of stay at the skilled nursing facility (-5.52 days; 95% CI, -9.61 to -1.43; P = .001). The 30-day mortality rate was not significantly lower in the intervention group (odds ratio 0.38; 95% CI, 0.11-1.24; P = .11).ConclusionPatients discharged to skilled nursing facilities participating in the ECHO-CT program had shorter lengths of stay, lower 30-day rehospitalization rates, and lower 30-day health care costs compared with those in matched skilled nursing facilities delivering usual care. ECHO-CT may improve patient transitions to postacute care at lower overall cost.Copyright © 2017 Elsevier Inc. All rights reserved.

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