Impact of the EAGLEcareACT Telehealth Program on Emergency Department Outcomes Among Nursing Home Residents: A...

We developed the Enhancing Advance Care Planning, Geriatric Care and End-of-Life Care Acute Care Team (EAGLEcareACT) program that provided structured training, care pathways, and teleconsultation to nursing homes (NHs). This study examined the association between EAGLEcareACT participation and appropriate emergency department (ED) utilization among NH residents.

Retrospective cohort study.

NH residents aged ≥60 who presented to an acute tertiary hospital's ED in Singapore between January 1, 2020, and December 31, 2023. Residents from EAGLEcareACT-partnered NHs were compared with those from nonpartnered NHs.

De-identified ED attendance data were analyzed, and visits were classified by triage acuity, National Early Warning Score (NEWS), and hospitalization outcome. Generalized estimating equation (GEE) models with inverse probability weighting and adjustment were applied to estimate associations between EAGLEcareACT status and outcomes.

A total of 6344 ED attendances among NH residents were evaluated. In the fully adjusted analyses, compared with NH residents from nonpartnered NHs, those from EAGLEcareACT-partnered NHs were more severely ill (NEWS: β = 0.37, 95% CI, 0.17-0.56), had greater odds of high NEWS (≥7) (OR, 1.16; 95% CI, 1.02-1.31), and were likely to be presented with highest acuity at the ED (OR, 1.28; 95% CI, 1.14-1.45). However, there was no significant association with likelihood of hospitalization (OR, 1.02; 95% CI, 1.00-1.04).

EAGLEcareACT was associated with improved triage appropriateness, identifying those who truly required acute care. These findings support EAGLEcareACT as a scalable model to improve the quality of acute telemedical care for NH residents.