Abstract 14169: Avoiding Unnecessary Transfers & Expensive Hospitalization for AMI Patients With Application of Telemedicine Protocols

IntroductionLatin America Telemedicine Infarct Network (LATIN) utilized telemedicine to construct a population-based, hub and spoke AMI program in Brazil, Colombia and Mexico. We have previously reported on LATIN increasing access and accuracy and applying guidelines-based AMI managementHypothesisCan a telemedicine strategy for AMI management reduce costs? What is the cost benefit analysis (CBA) for avoiding patient transfer, hospitalization and treatment with such a strategy?Methods610,427 telemedicine encounters in LATIN spokes (small clinics and primary health centers in remote areas) were evaluated. CBA was individually conducted at hubs, spokes and telemedicine centers, and it included technology, transfer, inpatient and procedure-related savings. Sensitivity analysis was conducted by examining the worst and best scenarios of costs, revenues and savings. A comparison with recently reported data at Avera e-Emergency program in Sioux Falls, SD, involving 85 rural hospitals in 7 states is provided (13% transfer avoidance).ResultsAmong the 610,427 screened patients, 6,916 had STEMI (1.13%). Of these, 3,101 (44.8%) were treated with urgent reperfusion, including 2,405 (77.6%) with PPCI. Time to Telemedicine Diagnosis (TTD) was 4.1 min. With this efficient triage strategy, expensive additional care for the non-AMI patients was controlled. LATIN process costs, including IT infrastructure and expert guidance were $172; transfer and indirect patient costs, $688. Net savings, per telemedicine encounter, were $516. The calculated overall savings, till date, for LATIN range between $93.1 million (30% transfer avoidance, best scenario) to $31 million (10% transfer avoidance, worse scenario).ConclusionsTelemedicine is an extremely cost-effective strategy for constructing population-based AMI platforms. The hefty savings result from accurate telemedicine diagnosis and triage that prevent unnecessary transfer and hospitalization.