Background: Around one in five Americans live in rural areas, but only 5 percent of physicians practice in these same areas. As such, hospital located in rural area such as Roosevelt Rehabilitation and Specialty Hospitals (RRHS) struggle with physician staffing. Tele-hospital medicine has expanded rapidly since the Coronavirus Preparedness and Response Supplemental Appropriations Act in March 2020 and has the potential to help mitigate the physician shortage in rural areasThe Hospital Medicine Division at Wellstar MCG Health established a Telehospitalist program in August 2021 to help provide medicine coverage at RRHS.
Purpose: We aimed to evaluate clinical outcome measures of a newly implemented telehospitalist program 2 years after its implementation and compare them to regional and national data. Our hypothesis is that the Telehospitalist program in an inpatient rehabilitation facility can deliver care that is as safe and effective as usual in person care and improves quality measure at the facility.
Description: We analyze the data for the patients admitted at Roosevelt Warm Spring Rehabilitation Hospital, seen by the tele-hospital medicine program from August 2021-August 2023. A total of 371 patients seen during FY22 and 340 seen so far for FY23. We compare important outcome measures for an inpatient rehabilitation facility such as Case mix index, Length of stay, Community discharges to available regional and national data. . Prior to implementing the Telehospitalist program, LOS in FY20 was 17.07. LOS decreased to 15.54 in FY2021 and further decrease to 13.45 in FY2022. So far for FY2023 in June 2023, LOS is 14.37. LOS is now comparable to national and regional average at 14.46 and 14.57 respectively. CMI in FY22 and FY23 were at 1.42 and 1.45 where as regional and national were 1.48 and 1.49 respectively in FY23 and 1.49 and .1.51 in FY22. The facility community discharge was 83% in FY22 and 77.06% in FY23 which is similar to FY23 national average at 77.08% and regional at 78.8% and FY22 national average at 77% and regional at 78.15%
Conclusions: This study suggests that implementing a telehospitalist program in a rehabilitation facility did not affect the quality of the care provided when compared to regional and national metrics. In fact, the facility was able to improve the care it provided as evidence by improved length of stay, have staffing stability using telehospitalists while continuing to provide safe, effective, and comparable to usual in-person care.
