ICU telemedicine and critical care mortality: A national effectiveness study

Tri Quang Le; Jeremy M Kahn; Tri Quang Le; Amber E Barnato; Marilyn Hravnak; Courtney C Kuza; Francis Pike; Derek C Angus

ICU telemedicine and critical care mortality

A national effectiveness study

Kahn, J. M., Le, T. Q., Barnato, A. E., Hravnak, M., Kuza, C. C., Pike, F., & Angus, D. C. (2016). ICU telemedicine and critical care mortality: A national effectiveness study. Medical Care, 54(3), 319-325. https://doi.org/10.1097/MLR.0000000000000485

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Abstract

BACKGROUND: Intensive care unit (ICU) telemedicine is an increasingly common strategy for improving the outcome of critical care, but its overall impact is uncertain.

OBJECTIVES: To determine the effectiveness of ICU telemedicine in a national sample of hospitals and quantify variation in effectiveness across hospitals.

RESEARCH DESIGN: We performed a multicenter retrospective case-control study using 2001-2010 Medicare claims data linked to a national survey identifying US hospitals adopting ICU telemedicine. We matched each adopting hospital (cases) to up to 3 nonadopting hospitals (controls) based on size, case-mix, and geographic proximity during the year of adoption. Using ICU admissions from 2 years before and after the adoption date, we compared outcomes between case and control hospitals using a difference-in-differences approach.

RESULTS: A total of 132 adopting case hospitals were matched to 389 similar nonadopting control hospitals. The preadoption and postadoption unadjusted 90-day mortality was similar in both case hospitals (24.0% vs. 24.3%, P=0.07) and control hospitals (23.5% vs. 23.7%, P<0.01). In the difference-in-differences analysis, ICU telemedicine adoption was associated with a small relative reduction in 90-day mortality (ratio of odds ratios=0.96; 95% CI, 0.95-0.98; P<0.001). However, there was wide variation in the ICU telemedicine effect across individual hospitals (median ratio of odds ratios=1.01; interquartile range, 0.85-1.12; range, 0.45-2.54). Only 16 case hospitals (12.2%) experienced statistically significant mortality reductions postadoption. Hospitals with a significant mortality reduction were more likely to have large annual admission volumes (P<0.001) and be located in urban areas (P=0.04) compared with other hospitals.

CONCLUSIONS: Although ICU telemedicine adoption resulted in a small relative overall mortality reduction, there was heterogeneity in effect across adopting hospitals, with large-volume urban hospitals experiencing the greatest mortality reductions.