*Terry Rabinowitz, MD, FAPM, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT
Michael A. Ricci, MD, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT
Michael P. Caputo, Jr., MS, University of Vermont College of Medicine
Katharine M. Murphy, PhD, RN, Hebrew Rehabilitation Center for Aged, Boston, MA

Abstract:  To comply with federal mandates regarding access to psychiatric consultation and treatment, a community hospital in rural New York requested consultation to their nursing home residents identified by Minimum Data Set (MDS) criteria.  The MDS is an assessment and care-planning instrument mandated for use in all Medicare/Medicaid-funded US nursing homes.

All data are reviewed by a psychiatrist who receives the resident's most recent full and quarterly MDS assessment.  MDS data are a key component in the assessment and scales embedded in the instrument serve as an aid to diagnosis.  Subsequent MDS assessments are queried to evaluate response to treatment.  RN's at the nursing home facilitate the interview and to serve as local support.

To date, 24 new and 10 follow-up consultations were performed.  Resident average age was 81 years (±11.8).  Sixty-seven percent were female.  Depression, dementia, and delirium each comprised 21% of the principal psychiatric diagnoses, while adjustment disorder was present in 12.5%.  Behavioral disturbances were identified in 17% of the residents and were often exacerbated by hearing or vision problems.  Patient, consultee, and nurse satisfaction has been high.

These preliminary findings suggest that MDS data are an important facilitating component for telepsychiatry consultations performed for an elderly nursing home population and show promise for clinical and research applications.

Bio: Associate Professor of Psychiatry and of Family Practice, University of Vermont College of Medicine; Director, Psychiatric Consultation Service, Fletcher Allen Health Care (FAHC), Burlington, VT.  Developed and implemented the first Telepsychiatry Service at FAHC; preliminary results reported in this abstract.

Research focuses on psychiatric assessment and instrument development, psychiatric care of terminally ill patients, use of psychostimulants, and treatment of anxiety and depression in patients with comorbid illness.  Much of my research is focused on Minimum Data Set (MDS) and related instruments. 

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