Clinical Performance of the Remote After-Hours Telemedicine Medical Officer of the Day (Tele-MOD) Program: A Cohort Study.

OBJECTIVES: The aim of this study was to examine the clinical performance of the Telemedicine Medical Office of the Day (Tele-MOD) program, an after-hours telemedicine service, focusing on transfers and video visits, including utilization and cost savings, at two Community Living Centers (VA nursing homes). DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Using administrative data, we assessed Tele-MOD visits at 2 VA nursing homes from April 2023 through June 2024. METHODS: We described the demographics for Veterans seen by the Tele-MOD program, including those associated with video visits. We also compared rates of emergency department (ED) visits and hospitalization for the 30 days before and after each resident's initial Tele-MOD visit. Finally, we estimated costs associated with the care of each resident seen by the Tele-MOD program. RESULTS: The Tele-MOD program completed 3949 visits, serving 492 unique Veterans. Most Veterans were male (97%), White (79%), with a mean age of 76.2 (±10.4) years. Only 12.6% of visits involved video visits with residents; most were managed telephonically. The conditions most associated with video visits were signs and symptoms of abnormal findings including infection, and external causes of morbidity including injuries (P = .001 and P < .001, respectively). ED visits decreased 33.2% and 6.1% for VA and non-VA (ie, community care) settings, respectively; hospitalizations decreased 49.4% and 10.3% for VA and non-VA hospitals, respectively (P < .001 for both). All-cause 30-day readmission rates decreased 54.9% (P < .001). The estimated costs of care declined $45,538 per Veteran (P < .001). CONCLUSION AND IMPLICATIONS: Our findings indicate that the Tele-MOD program reduced ED visits, hospitalizations, 30-day readmission rates, and cost of VA and community care of VA nursing home residents. Furthermore, they suggest that the dissemination of the Tele-MOD program to additional VA nursing homes may yield similar benefits for more Veterans, as well as cost savings.