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Whetten J, van der Goes DN, Tran H, Moffett M, Semper C, Yonas H. Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program. J Med Econ 2018; 21:398-405. [PMID: 29316820 DOI: 10.1080/13696998.2018.1426591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio-visual program linking remote emergency department physicians and their patients to stroke specialists. ACCESS also has an education component in which hospitals receive training from stroke specialists on the triage and treatment of patients. This study assessed the clinical and economic outcomes of the ACCESS program in providing services to rural New Mexico from a healthcare payer perspective. METHODS A decision tree model was constructed using findings from the ACCESS program and existing literature, the likelihood that a patient will receive a tissue plasminogen activator (tPA), cost of care, and resulting quality adjusted life years (QALYs). Data from the ACCESS program includes emergency room patients in rural New Mexico from May 2015 to August 2016. Outcomes and costs have been estimated for patients who were taken to a hospital providing neurological telecare and patients who were not. RESULTS The use of ACCESS decreased neuro-emergent stroke patient transfers from rural hospitals to urban settings from 85% to 5% (no tPA) and 90% to 23% (tPA), while stroke specialist reading of patient CT/MRI imaging within 3 h of onset of stroke symptoms increased from 2% to 22%. Results indicate that use of ACCESS has the potential to save $4,241 ($3,952-$4,438) per patient and increase QALYs by 0.20 (0.14-0.22). This increase in QALYs equates to ∼73 more days of life at full health. The cost savings and QALYs are expected to increase when moving from a 90-day model to a lifetime model. CONCLUSION The analysis demonstrates potential savings and improved quality-of-life associated with the use of ACCESS for patients presenting to rural hospitals with acute ischemic stroke (AIS).
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Affiliation(s)
- Justin Whetten
- a Department of Economics , University of New Mexico , Albuquerque , NM , USA
| | | | - Huy Tran
- b Department of Neurosurgery , University of New Mexico , Albuquerque , NM , USA
| | - Maurice Moffett
- a Department of Economics , University of New Mexico , Albuquerque , NM , USA
| | - Colin Semper
- b Department of Neurosurgery , University of New Mexico , Albuquerque , NM , USA
| | - Howard Yonas
- b Department of Neurosurgery , University of New Mexico , Albuquerque , NM , USA
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Abu-Laban RB, Drebit S, Lindstrom RR, Archibald C, Eggers K, Ho K, Khazei A, Lund A, MacKinnon C, Markham R, Marsden J, Martin E, Christenson J. The British Columbia Emergency Medicine Network: A Paradigm Shift in a Provincial System of Emergency Care. Cureus 2018. [PMID: 29531875 PMCID: PMC5837260 DOI: 10.7759/cureus.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new “Emergency Medicine Network” (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.
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Affiliation(s)
| | - Sharla Drebit
- Department of Emergency Medicine, University of British Columbia
| | | | | | | | - Kendall Ho
- Department of Emergency Medicine, University of British Columbia
| | - Afshin Khazei
- Department of Emergency Medicine, University of British Columbia
| | - Adam Lund
- Deparment of Emergency Medicine, University of British Columbia
| | | | - Ray Markham
- Department of Family Practice, University of British Columbia
| | - Julian Marsden
- Department of Emergency Medicine, University of British Columbia
| | | | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia
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Sasikala S, Indhira K, Chandrasekaran V. Performance prediction of interactive telemedicine. INFORMATICS IN MEDICINE UNLOCKED 2018. [DOI: 10.1016/j.imu.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Depth accuracy of the RealSense F200: Low-cost 4D facial imaging. Sci Rep 2017; 7:16263. [PMID: 29176666 PMCID: PMC5701257 DOI: 10.1038/s41598-017-16608-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/07/2017] [Indexed: 01/23/2023] Open
Abstract
The RealSense F200 represents a new generation of economically viable 4-dimensional imaging (4D) systems for home use. However, its 3D geometric (depth) accuracy has not been clinically tested. Therefore, this study determined the depth accuracy of the RealSense, in a cohort of patients with a unilateral facial palsy (n = 34), by using the clinically validated 3dMD system as a gold standard. The patients were simultaneously recorded with both systems, capturing six Sunnybrook poses. This study has shown that the RealSense depth accuracy was not affected by a facial palsy (1.48 ± 0.28 mm), compared to a healthy face (1.46 ± 0.26 mm). Furthermore, the Sunnybrook poses did not influence the RealSense depth accuracy (p = 0.76). However, the distance of the patients to the RealSense was shown to affect the accuracy of the system, where the highest depth accuracy of 1.07 mm was measured at a distance of 35 cm. Overall, this study has shown that the RealSense can provide reliable and accurate depth data when recording a range of facial movements. Therefore, when the portability, low-costs, and availability of the RealSense are taken into consideration, the camera is a viable option for 4D close range imaging in telehealth.
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Clay-Williams R, Baysari M, Taylor N, Zalitis D, Georgiou A, Robinson M, Braithwaite J, Westbrook J. Service provider perceptions of transitioning from audio to video capability in a telehealth system: a qualitative evaluation. BMC Health Serv Res 2017; 17:558. [PMID: 28806903 PMCID: PMC5557607 DOI: 10.1186/s12913-017-2514-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/07/2017] [Indexed: 11/24/2022] Open
Abstract
Background Telephone consultation and triage services are increasingly being used to deliver health advice. Availability of high speed internet services in remote areas allows healthcare providers to move from telephone to video telehealth services. Current approaches for assessing video services have limitations. This study aimed to identify the challenges for service providers associated with transitioning from audio to video technology. Methods Using a mixed-method, qualitative approach, we observed training of service providers who were required to switch from telephone to video, and conducted pre- and post-training interviews with 15 service providers and their trainers on the challenges associated with transitioning to video. Two full days of simulation training were observed. Data were transcribed and analysed using an inductive approach; a modified constant comparative method was employed to identify common themes. Results We found three broad categories of issues likely to affect implementation of the video service: social, professional, and technical. Within these categories, eight sub-themes were identified; they were: enhanced delivery of the health service, improved health advice for people living in remote areas, safety concerns, professional risks, poor uptake of video service, system design issues, use of simulation for system testing, and use of simulation for system training. Conclusions This study identified a number of unexpected potential barriers to successful transition from telephone to the video system. Most prominent were technical and training issues, and personal safety concerns about transitioning from telephone to video media. Addressing identified issues prior to implementation of a new video telehealth system is likely to improve effectiveness and uptake. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2514-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia.
| | - Melissa Baysari
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Natalie Taylor
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Dianne Zalitis
- Healthdirect Australia, Level 19, 133 Castlereagh St, Sydney, NSW, 2000, Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Maureen Robinson
- Healthdirect Australia, Level 19, 133 Castlereagh St, Sydney, NSW, 2000, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
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Schneider RB, Biglan KM. The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease. Lancet Neurol 2017; 16:541-551. [DOI: 10.1016/s1474-4422(17)30167-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/02/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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Muriel Fernandez J, Sánchez Ledesma MJ, López Millan M, García Cenador MB. Study of the uses of Information and Communication Technologies by Pain Treatment Unit Physicians. J Med Syst 2017; 41:78. [PMID: 28349348 DOI: 10.1007/s10916-017-0726-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/17/2017] [Indexed: 11/28/2022]
Abstract
Adequate use of Information and Communication Technologies (ICTs) in health has been shown to save the patient and caregiver time, improve access to the health system, improve diagnosis and control of disease or treatment. All this results in cost savings, and more importantly, they help improve the quality of service and the lives of patients. The purpose of this study is to analyse the differences in the uses of this ICTs between those physicians that belong to Pain Treatment Units (PU) and other physicians that work in pain not linked to these PUs. An online survey, generated by Netquest online survey tool, was sent to both groups of professionals and the data collected was statistical analysed through a logistic regression methodology which is the Logit binomial model. Our results show that those physicians that belong to PUs use ICTs more frequently and consider it more relevant to their clinical practice.
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Affiliation(s)
- Jorge Muriel Fernandez
- Department of Surgery, School of Medicine, University of Salamanca, Avda Alfonso X El Sabio s/n, 37007, Salamanca, Spain.
| | | | - Manuel López Millan
- Anaesthesiology Service, University Hospital Virgen Macarena, Sevilla, Spain
| | - María Begoña García Cenador
- Department of Surgery, School of Medicine, University of Salamanca, Avda Alfonso X El Sabio s/n, 37007, Salamanca, Spain
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AlDossary S, Martin-Khan MG, Bradford NK, Armfield NR, Smith AC. The Development of a Telemedicine Planning Framework Based on Needs Assessment. J Med Syst 2017; 41:74. [PMID: 28321589 DOI: 10.1007/s10916-017-0709-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/22/2017] [Indexed: 11/26/2022]
Abstract
Providing equitable access to healthcare services in rural and remote communities is an ongoing challenge that faces most governments. By increasing access to specialty expertise, telemedicine may be a potential solution to this problem. Regardless of its potential, many telemedicine initiatives do not progress beyond the research phase, and are not implemented into mainstream practice. One reason may be that some telemedicine services are developed without the appropriate planning to ascertain community needs and clinical requirements. The aim of this paper is to report the development of a planning framework for telemedicine services based on needs assessment. The presented framework is based on the key processes in needs assessment, Penchansky and Thomas's dimensions of access, and Bradshaw's types of need. This proposed planning framework consists of two phases. Phase one comprises data collection and needs assessment, and includes assessment of availability and expressed needs; accessibility; perception and affordability. Phase two involves prioritising the demand for health services, balanced against the known limitations of supply, and the implementation of an appropriate telemedicine service that reflects and meets the needs of the community. Using a structured framework for the planning of telemedicine services, based on need assessment, may help with the identification and prioritisation of community health needs.
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Affiliation(s)
- Sharifah AlDossary
- Centre for Online Health, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital Woolloongabba, Brisbane, QLD, 4102, Australia.
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Melinda G Martin-Khan
- Centre for Online Health, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital Woolloongabba, Brisbane, QLD, 4102, Australia
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia
| | - Natalie K Bradford
- Queensland Youth Cancer Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Nigel R Armfield
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital Woolloongabba, Brisbane, QLD, 4102, Australia
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