Mayo Clinic Study Demonstrates Telehealth's Value to Rural Hospitals

Two rural hospitals using an asynchronous telehealth platform for eConsults with infectious disease experts saw a sharp reduction in risk of death within 30 days, as well as a decreased risk of rehospitalization.

In a 2018 study conducted by The Mayo Clinic at two hospitals within its network, the connected health platform helped staff at these hospitals collaborate with ID specialists at Mayo’s Rochester hospital on care management for some 100 patients. Through the eConsult platform, those experts were able to recommend interventions like antibiotic type change, antibiotic duration change, antibiotic de-escalation, additional lab testing and consults with other specialists.

“We believe that this study demonstrates the utility of an asynchronous approach to infectious diseases care for patients hospitalized at locations without in-person ID specialists,” Aaron J. Tande, MD, an infectious diseases specialist at the Mayo Clinic and the study’s lead author, told Healio. “This approach allows a more in-depth evaluation of a patient than a typical ‘curbside’ phone call but avoids the complexity of synchronous/video telehealth.”

“This is a potential option for small hospitals that are on the same electronic record as larger hospitals that have infectious diseases specialists,” he added. “We feel that the future of ID telemedicine should include a variety of options individualized to the complexity and needs of each individual patient and capabilities of each health care facility.”

The study, conducted at the Mayo Clinic’s Austin Hospital and Albert Lea Hospital in southeastern Minnesota, saw a 70 percent reduced risk of death within 30 days and a trend toward decreased readmission within 30 days. And while it showed an increase in length of stay, Tande and his colleagues noted that the eConsults were conducted a few days into the hospitalization, and that an earlier consult would likely reduce the length of stay.

Tande and his colleagues said 18 of the 19 hospitalists involved in the telehealth program were “very satisfied” with the service, including its integration with the health system’s electronic health record platform. They attributed this to the use of an asynchronous – also known as store-and-forward – telemedicine platform, which fits more snugly into provider workloads and reduces interruptions in patient care.

This type of platform also benefits small and rural hospitals with few resources, they noted.

“We deliberately chose to pursue an asynchronous approach that minimizes barriers to implementation,” they wrote in the study. “eConsultation is easily scalable and requires minimal capital investment or ongoing time commitment on the part of the referring facility, which is particularly apropos to rural or critical access hospitals. We developed infrastructure within our consultative practice to facilitate same-day evaluation, which is critical to timely evaluation of acutely ill patients.”

“In summary, asynchronous ID eConsultation is a viable option for hospitals without in-person ID consultation,” they concluded. “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.”