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J Am Med Dir Assoc. 2019 Feb;20(2):115-122. doi: 10.1016/j.jamda.2018.11.022.

Standards for the Use of Telemedicine for Evaluation and Management of Resident Change of Condition in the Nursing Home.

Author information

Canandaigua VA Medical Center, Canandaigua, NY; Division of Geriatrics and Aging, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY. Electronic address:
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
Department of Family Medicine, University of Toledo, Toledo, OH.
AbsoluteCARE Baltimore (Patient Centered Ambulatory ICU Medical Center), Baltimore, MD.
eCARE Senior Care, Avera Health, Sioux Falls, SD.
Division of Geriatrics and Aging, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA.



This document offers guidance to clinicians and facilities on the use of telemedicine to deliver medically necessary evaluation and management of change of condition for nursing home residents.


Members of the telemedicine workgroup of AMDA-The Society for Post-Acute Long-Term Medicine-developed this guideline through both telephonic and face-to-face meetings between April 2017 and September 2018. The guideline is based on the currently available research, experience, and expertise of the workgroup's members, including a summary of a recently completed systematic mixed studies literature review to determine evidence for telemedicine to reduce emergency department visits or hospitalizations of nursing home residents.


Research and experience to date support the use of telemedicine as a tool in change of condition assessment and management as a means of reducing unnecessary emergency department visits and hospitalization. Telemedicine-delivered care should be integrated into the primary care of the resident and delivered by providers with competency in post-acute long-term care. The development and sustainability of telemedicine programs is heavily dependent on financial implications. Quality measures should be defined for telemedicine programs in nursing homes.


Telemedicine programs in nursing homes can contribute to the delivery of timely, high quality medical care, which reduces unnecessary hospitalization. Reimbursement for telemedicine-driven care should be based upon medical necessity of visits to care and the maintenance of quality standards. More studies are needed to understand which telemedicine tools and processes are most effective in improving outcomes for nursing home residents.


Telemedicine; emergency service; hospital; hospitalization; nursing homes

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