Critical illness represents an enormous clinical and financial burden on the United States Health care system. Over 4 million patients are admitted to an intensive care unit each year, and ICU related costs exceed $50 billion annually. ICU telemedicine is a health care innovation that combines clinical expertise with electronic monitoring systems to improve the quality and safety of intensive care. Little evidence exists to guide adoption of telemedicine in the United States, yet these programs are expanding at a rapid rate, with substantial financial cost to the health system. In order to better inform health policy, a diverse program of research is needed to determine the organizational and system-level factors that modify the effectiveness of telemedicine programs, as well as the role of ICU telemedicine in patient safety, evidence-based practice, patient satisfaction and medical education. We propose a comprehensive interdisciplinary conference to develop and disseminate a research agenda for ICU telemedicine. The conference will bring together a diverse group of experts in critical care, health services research, health economics, information technology, patient safety and organizational science. The goals of the conference will be to: (a) critically examine the state of the science underlying ICU telemedicine, (b) reach consensus on a common lexicon for critical care delivery through telemedicine, (c) identify important knowledge gaps in ICU telemedicine within the context of current ICU services in the US and (d) assess the scientific and methodological approaches necessary to fill these knowledge gaps. The conference will be organized and managed by critical care health services researchers with extensive experience in interdisciplinary workshop planning, with the support of the Quad Critical Care Professional Societies, an established collaboration of the four major critical care specialty societies. We will utilize a standardized iterative consensus process to determine important knowledge gaps in ICU telemedicine and develop a comprehensive research agenda. Conference proceedings will be published in a peer reviewed journal and disseminated through the internet and targeted direct mailings to key stakeholders. Overall, the results of this conference will provide essential foundation for future research in ICU telemedicine with the goal of improving the quality and safety of health care for patients with critical illness.
Relevance of this topic to AHRQ priority populations The AHRQ mission is """"""""to improve the quality, safety, efficiency, and effectiveness of care for all Americans."""""""" This conference directly addresses an innovative approach to improve the quality and safety of critical care, especially to rural and minority populations. Rural health is an important policy problem in the US and a key population of interest to the Agency for Healthcare Research and Quality. Studies consistently show that rural populations have decreased access to high quality health care, both in primary care and in the hospital setting. Approximately 34% of US hospitals with ICUs are located in rural areas. A recent report on the critical care workforce by the Health Resources and Service Administration specifically cited the lack of trained critical care clinicians in rural hospitals as a major public health problem. Rural urban disparities disproportionately affect the elderly, military veterans, Latino, and indigenous populations, other populations of interest to AHRQ. Research addressing these disparities is a vital component of efforts to improve overall health care quality. Telemedicine is also a patient safety innovation with potential effects that transcend regional health disparities. Applied effectively, telemedicine could reduce preventable harm in all American ICUs, significantly impacting ICU quality as a whole.