D-HH and West Health bring geriatric emergency care and telehealth services to rural hospitals

Dartmouth-Hitchcock Health (D-HH), New Hampshire's only academic health system serving nearly 2 million patients across northern New England, and West Health, a family of nonprofit and nonpartisan organizations working to lower health care costs to enable successful aging, are bringing accredited geriatric emergency care and, for the first time, providing older adults in the region with specialized telehealth services from an accredited emergency department. Northern New England is home to one of the fastest-growing senior populations in the country.

D-HH and West Health announced today that they will provide telehealth services and geriatric emergency department (GED) training, education and other resources to four rural hospitals in a two-phase "hub and spoke" approach. The first two hospitals to receive telemedicine support from Dartmouth-Hitchcock Medical Center (DHMC) will be Alice Peck Day Memorial Hospital in Lebanon, and Mt. Ascutney Hospital and Health Center in Windsor, VT, both members of the D-HH system. Valley Regional Hospital in Claremont, NH, and Gifford Medical Center in Randolph, VT, will be brought on in phase two. All four spoke sites will gain access to supplemental telehealth services provided by DHMC with an emphasis on geriatric nursing, transitional care management, and support of on-call geriatricians. These new partnerships will enable the four hospitals to earn national accreditation as Level 2 GEDs from the American College of Emergency Physicians (ACEP).

Our location in the Upper Valley positions us right between New Hampshire and Vermont, which have two of the most rapidly aging populations of all 50 states. The COVID-19 pandemic has laid bare the need for telemedicine services and quality critical access hospitals more than ever, especially for elderly people who may struggle to get to doctor's appointments or to a hospital in an emergency. Alice Peck Day Memorial Hospital is proud to be part of D-HH and West Health's efforts to improve access to this vulnerable population."

Michael Lynch, MD, Chief Medical Officer at Alice Peck Day

The initiative is the latest to emerge from a 2019 three-year research collaboration between West Health and D-HH, which also includes the creation of the nation's first Level 1 accredited rural GED within DHMC. Its completion is expected in early 2021. Nearly 200 hospitals have received GED accreditation in the U.S.; nationally, only 12 hospitals have achieved Level 1 accreditation, all of which besides DHMC are in urban areas.

"The ability to offer GED services and the option of telehealth to our patients is a significant asset, and sets us and other 'spoke' sites apart from other small hospitals in our region," said Joseph Perras, MD, Chief Executive Officer and Chief Medical Officer at Mt. Ascutney. "We want our patients, especially the elderly, to know that they don't need to travel outside their community to receive quality care that's tailored to their needs. Mt. Ascutney's inclusion in D-HH and West Health's GED program is critical for our efforts to serve our community's aging population."

According to the U.S. Census Bureau, more than 46 million seniors live in the United States with about 1 in 5 residing in rural areas where access to healthcare and transportation may be limited. Older adults account for about 20% of all emergency department visits and are more likely to have multiple chronic diseases and suffer from cognitive issues, social isolation, loneliness, poverty and food insecurity than their younger counterparts.

"Geriatric emergency departments promote best clinical practices for older adults, create a more positive and sensitive physical environment and help improve health outcomes, better coordinate care, and reduce costs," said Shelley Lyford, president and chief executive officer of West Health. "We are pleased to be working with Dartmouth-Hitchcock to extend its reach to rural hospitals and bring the power of geriatric emergency care and telehealth to more patients throughout the region."

"We are in a unique situation at Dartmouth-Hitchcock, as the two states we serve have large populations of older adults," said Scott Rodi, MD, chair of Emergency Medicine at DHMC. "When we partnered with West Health to create our GED program, we knew that working with critical access hospitals in our region would be the key to delivering the best, most comprehensive care to this population. We're proud to roll out our first two 'spoke' sites at our affiliate hospitals Mt. Ascutney and Alice Peck Day in phase one, and look forward to working with Valley Regional and Gifford in phase two."

The lessons learned from these collaborations will enable D-HH and West Health to determine the effectiveness of using telemedicine to extend geriatric emergency care to other rural hospitals across the country.

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