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Dilger AE, Meiklejohn DA, Bent JP, Tummala N, Bergmark RW, Lalakea ML. Climate change and environmental sustainability in otolaryngology: A state-of-the-art review. Surgeon 2024:S1479-666X(24)00065-9. [PMID: 38972805 DOI: 10.1016/j.surge.2024.06.007] [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: 06/02/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Climate change has been identified by the World Health Organization (WHO) as the greatest existing threat to human health. Given the direct exposure of the upper aerodigestive system to pollutants, patients in otolaryngology are at high risk for increased disease burden in the setting of climate change and worsening air quality. Given this and the environmental impact of surgical care, it is essential for surgeons to understand their role in addressing climate health through quality-driven clinical initiatives, education, advocacy, and research. METHODS A state-of-the-art review was performed of the existing literature on the otolaryngologic health impacts of climate change and environmental sustainability efforts in surgery with specific attention to studies in otolaryngology - head and neck surgery. FINDINGS Climate variables including heat and air pollution are associated with increased incidence of allergic rhinitis, chronic rhinosinusitis and head and neck cancer. A number of studies have shown that sustainability initiatives in otolaryngology are safe and provide direct cost benefit. CONCLUSION Surgeons have the opportunity to lead on climate health and sustainability to address the public health burden of climate change.
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Affiliation(s)
- Amanda E Dilger
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
| | - Duncan A Meiklejohn
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - John P Bent
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neelima Tummala
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Regan W Bergmark
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Otolaryngology - Head and Neck Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - M Lauren Lalakea
- Division of Otolaryngology - Head and Neck Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Young VN, Ma Y, Rosen CA, Schneider SL. Medicare Restriction of Telehealth Speech Services Negatively Impacts Patient Care. Otolaryngol Head Neck Surg 2024. [PMID: 38613195 DOI: 10.1002/ohn.779] [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: 11/10/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Ample literature shows voice and swallowing therapy, in-person or virtual, to be essential for Otolaryngology and Speech-Language Pathology care. In March 2023, Medicare announced discontinuing teletherapy reimbursement in hospital-based outpatient departments, effective May 2023. This decision was subsequently reversed; however, the uncertain interval period provided the opportunity to study the impact of eliminating teletherapy. STUDY DESIGN Prospective cohort. SETTING Tertiary laryngology center. METHODS Affected Medicare patients were contacted via mailed letter, phone, and secure patient portal and offered to change appointments to in-person, teletherapy with cash self-payment ($165-282/session) or cancellation. Demographics and responses were collected. Statistical analyses conducted using Student's t test. RESULTS Fifty-three patients (28 female; mean age 66.8 ± 14.2 years) were impacted. 64% (n = 34) changed to in-person appointment, 28% (n = 15) canceled, 8% (n = 4) did not respond. No patients opted to self-pay. 67% of patients that canceled telehealth care cited distance from in-person care location. The mean distance for canceled versus rescheduled patients was 92.3 ± 93.0 versus 32.8 ± 57.4 miles, P = .034. Mean age, gender, and number of sessions were not different between groups. Mean time to third next available therapy appointment was 96 ± 46 versus 46 ± 12 days before and after rule change, P = .007. Upon Medicare's reversal, this trend rebounded to nearly baseline (mean 77 ± 12 days, P = .12). CONCLUSION Medicare's discontinuation of reimbursement for teletherapy services caused nearly 30% of patients to cancel voice and swallowing therapy, primarily due to distance. These cancellations led to decreased access to care for Medicare patients with voice/swallowing diagnoses, which affect function, quality of life, and potentially even mortality risk.
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Affiliation(s)
- VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, USA
| | - Yue Ma
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, USA
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, USA
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Heffernan A, Lalande A, Chadha R, MacNeill A, Chadha NK. Carbon savings potential of virtual care in obstructive sleep apnea and otitis media with effusion. Laryngoscope Investig Otolaryngol 2024; 9:e1221. [PMID: 38623079 PMCID: PMC11017970 DOI: 10.1002/lio2.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 04/17/2024] Open
Abstract
Objective To determine the carbon savings potential of incorporating virtual care into surgical care pathways for pediatric patients with obstructive sleep apnea or otitis media with effusion. Methods Pediatric patients with obstructive sleep apnea or otitis media with effusion were not enrolled, instead, a modeling cohort study design was used. This study utilized the British Columbia healthcare system and geography to model emissions. Care pathways were developed for pediatric patients with obstructive sleep apnea or otitis media with effusion requiring care at a tertiary pediatric center. Home addresses were located at the geographical center of the two most populated municipalities within each of the 10 most populated regional districts in 2020. Virtual visits replaced up to three clinically equivalent in-person visits. Emissions (kgCO2e) for transport and virtual visits were estimated. Population-weighted means and descriptive statistics were calculated. Results Utilizing 1, 2, or 3 virtual visits in the obstructive sleep apnea care pathway yielded potential emissions savings of 19.9%, 39.9%, and 59.8% respectively. Integrating 1, 2, or 3 virtual visits into the otitis media with effusion care pathway produced potential emissions savings of 16.6%, 33.2%, and 49.7%, respectively. Integrating 3 virtual visits can save up to 2156.8 kgCO2e per patient. Conclusions Appropriately conducting up to 50% of clinical encounters virtually for children with obstructive sleep apnea or otitis media with effusion reduced theoretical carbon emissions. For a single child, emission savings could reach over 2150 kgCO2e. Level of Evidence Level 5.
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Affiliation(s)
- Austin Heffernan
- Division of Otolaryngology‐Head and Neck Surgery, (Department of Surgery)University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Annie Lalande
- Institute for Resources, Environment and SustainabilityUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Rashmi Chadha
- Department of Family PracticeUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Andrea MacNeill
- Department of SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Neil K. Chadha
- Division of Otolaryngology‐Head and Neck Surgery, (Department of Surgery)University of British ColumbiaVancouverBritish ColumbiaCanada
- Division of Pediatric Otolaryngology‐Head and Neck SurgeryBC Children's HospitalVancouverBritish ColumbiaCanada
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Altamimi AA, Brennan-Jones CG, Robinson M, Kuthubutheen J, Herbert H, Tran TT, Veselinović T, Edmunds M, Oremulé B, Alenezi EM, Richmond PC, Choi RS, Li I. A hospital-based asynchronous ENT telehealth service for children with otitis media: Cost-minimisation and improved access. J Telemed Telecare 2024:1357633X231223994. [PMID: 38295365 DOI: 10.1177/1357633x231223994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
AIM The purpose of this study is to explore the effectiveness of a hospital-based asynchronous ear, nose, and throat (ENT) telehealth service (the Ear Portal) in reducing cost and improving access for children with otitis media. METHODS Participants were recruited to the Ear Portal from a tertiary hospital ENT waiting list. Ear and hearing assessments were conducted during appointments by the Ear Portal research assistant, and data was stored for an asynchronous review by the Ear Portal multidisciplinary team. A cost-minimisation analysis was conducted for the Ear Portal and the standard care pathways. Waiting times to provide care for both pathways were calculated for children with semi-urgent (i.e. Category 2) and non-urgent (i.e. Category 3) referrals. RESULTS The running cost for the Ear Portal was $67.70 for initial appointments and $37.34 for follow-up appointments. Conversely, the running cost for the standard care pathway was $154.65 for initial appointments and $86.10 for follow-up appointments. A total of 223 appointments were required to offset the initial Ear Portal investment of $19,384.00. The median waiting time for the Ear Portal from initial contact to care plan delivery was <30 days, whereas the median waiting times for children in the standard care pathway were 291 days (interquartile range (IQR) = 117) for Category 2 and 371 days (IQR = 311) for Category 3 referrals. CONCLUSION Under the current circumstances, the Ear Portal service can reduce costs for the health care system by reducing marginal costs per patient in addition to providing ENT specialist care within the clinically recommended timeframes.
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Affiliation(s)
- Ali Ah Altamimi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Faculty of Life Sciences, Kuwait University, Kuwait
| | - Christopher G Brennan-Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
- School of Allied Health, Curtin University, Perth, Western Australia
| | - Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | - Jafri Kuthubutheen
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | - Hayley Herbert
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | | | - Tamara Veselinović
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Human Sciences, The University of Western Australia, Perth, Western Australia
| | - Melinda Edmunds
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Allied Health, Curtin University, Perth, Western Australia
| | - Babatunde Oremulé
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Paediatric ENT Department, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Eman Ma Alenezi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Peter C Richmond
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | - Robyn Sm Choi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Human Sciences, The University of Western Australia, Perth, Western Australia
| | - Ian Li
- School of Management and Marketing, Curtin University, Perth, Western Australia
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Gallagher T, Choi JS, Garcia E, Chambers T, Ference E. Telemedicine in an Otolaryngology Clinic Serving the Incarcerated Population. Ann Otol Rhinol Laryngol 2023; 132:1321-1329. [PMID: 36647259 DOI: 10.1177/00034894221149547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE There is a paucity of data investigating the effect of implementation of telehealth on vulnerable populations, particularly the incarcerated. Our objective is to evaluate patient and physician satisfaction with telehealth (telephone visits) used in an outpatient otolaryngology clinic serving the incarcerated population. METHODS Incarcerated patients who were served by otolaryngologists via telephone visits from a large tertiary care center from June 2021 to January 2022 were included (n = 20) in this pilot study. Patient and physician satisfaction with the encounters were evaluated using the Telehealth Satisfaction Questionnaire and a modified physician satisfaction questionnaire, respectively. RESULTS Consultations for various otolaryngological complaints were completed via telephone for incarcerated patients including hearing loss, tinnitus, facial fracture, dysphonia, and tonsillitis. Mean patient and physician satisfaction scores were high at 4.25 ± 0.12 and 4.65 ± 0.13 respectively (score range 1-5). Patient satisfactions subdomain scores were 3.92 ± 0.13 for quality of care provided, 3.99 ± 0.13 for similarity to face-to-face encounter, and 4.2 ± 0.17 for perception of the interaction. Imaging or audiogram was available prior to appointment in 60% of cases, with labs, imaging, or audiogram ordered after in 40% of cases and initial pharmaceutical treatment provided to 10% of patients. 45% of patients required follow up in-person, while 40% were discharged pro re nata, and 15% were followed up with another phone visit. There was no statistically significant association between demographic or clinical characteristics and patient or physician satisfaction scores. CONCLUSIONS Consultations for various otolaryngological complaints were completed via telephone with high patient and physician satisfaction within an incarcerated population in this pilot study. Telephone visit is likely a feasible alternative format that can advance otolaryngological care. Studies with larger sample sizes are required to ensure quality of care and advance social justice for this chronically underserved population.
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Affiliation(s)
- Tyler Gallagher
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Janet S Choi
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA
| | - Erick Garcia
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Tamara Chambers
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Elisabeth Ference
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Hakanen O, Tolvi M, Torkki P. Cost analysis of face-to-face visits, virtual visits, and a digital care pathway in the treatment of tonsillitis patients. Am J Otolaryngol 2023; 44:103868. [PMID: 36996515 DOI: 10.1016/j.amjoto.2023.103868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE The aim of this study was to compare the costs of two different telemedicine-assisted tonsillitis care pathways with traditional face-to-face visits at the Department of Otorhinolaryngology - Head and Neck Surgery (ORL-HNS) at Helsinki University Hospital. METHODS We characterized and analyzed the patient flows and their individual episodes of all tonsillitis patients at the Department of ORL-HNS between September 2020 and August 2022. Records were collected by doctors at the clinic. We investigated costs and allocated resources in four categories: invoice from the Department of ORL-HNS to the public payer, expenses to the Department, patient fees, and doctor's resource. RESULTS At least a third of the tonsillitis patients were eligible for telemedicine. The digital care pathway was 12.6 % less expensive for the public payer compared to the previous virtual visit model. For the Department, the expense of the digital care pathway was 58.8 % less per patient than the virtual visit model. Patient fees decreased 79.5 %. The digital care pathway reduced the doctor's resource from 30.28 min to 19.78 min, which accounts for a 34.7 % reduction. Patients finished the digital care pathway in a median of 62 min (SD = 60) compared to the 2-4 h which they would spend on an outpatient clinic visit. CONCLUSION Our study demonstrates that tonsillitis patients are eligible for preoperative telemedicine. With at least a third of the tonsillitis patients being eligible for telemedicine, major cost savings can be achieved with efficient e-health-assisted solutions.
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Sillcox R, Gitonga B, Meiklejohn DA, Wright AS, Oelschlager BK, Bryant MK, Tarefder R, Khan Z, Zhu J. The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease. Surg Endosc 2023:10.1007/s00464-023-10131-9. [PMID: 37237107 DOI: 10.1007/s00464-023-10131-9] [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: 03/29/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Health care accounts for almost 10% of the United States' greenhouse gas emissions, accounting for a loss of 470,000 disability-adjusted life years based on the health effects of climate change. Telemedicine has the potential to decrease health care's carbon footprint by reducing patient travel and clinic-related emissions. At our institution, telemedicine visits for evaluation of benign foregut disease were implemented for patient care during the COVID-19 pandemic. We aimed to estimate the environmental impact of telemedicine usage for these clinic encounters. METHODS We used life cycle assessment (LCA) to compare greenhouse gas (GHG) emissions for an in-person and a telemedicine visit. For in-person visits, travel distances to clinic were retrospectively assessed from 2020 visits as a representative sample, and prospective data were gathered on materials and processes related to in-person clinic visits. Prospective data on the length of telemedicine encounters were collected and environmental impact was calculated for equipment and internet usage. Upper and lower bounds scenarios for emissions were generated for each type of visit. RESULTS For in-person visits, 145 patient travel distances were recorded with a median [IQR] distance travel distance of 29.5 [13.7, 85.1] miles resulting in 38.22-39.61 carbon dioxide equivalents (kgCO2-eq) emitted. For telemedicine visits, the mean (SD) visit time was 40.6 (17.1) min. Telemedicine GHG emissions ranged from 2.26 to 2.99 kgCO2-eq depending on the device used. An in-person visit resulted in 25 times more GHG emissions compared to a telemedicine visit (p < 0.001). CONCLUSION Telemedicine has the potential to decrease health care's carbon footprint. Policy changes to facilitate telemedicine use are needed, as well as increased awareness of potential disparities of and barriers to telemedicine use. Moving toward telemedicine preoperative evaluations in appropriate surgical populations is a purposeful step toward actively addressing our role in health care's large carbon footprint.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA.
| | - Baraka Gitonga
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Andrew S Wright
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Brant K Oelschlager
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Mary Kate Bryant
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Rafiqul Tarefder
- Department of Civil, Construction and Environmental Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Zafrul Khan
- Department of Civil, Construction and Environmental Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Jay Zhu
- Department of Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
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Karp EE, Yin LX, Xie KZ, O'Byrne TJ, Wallerius KP, Tasche KK, Van Abel KM, Kasperbauer JL, Moore EJ, Price DL. Safety outcomes and patient convenience in outpatient parotidectomy. Am J Otolaryngol 2023; 44:103806. [PMID: 36842422 DOI: 10.1016/j.amjoto.2023.103806] [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: 10/08/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Parotidectomies have historically been performed on an inpatient basis despite being well-tolerated surgeries with minimal postoperative wound care and low rates of complications at high-volume institutions. Past studies have supported the safety of outpatient surgery for parotidectomy but have been limited to superficial parotidectomy and have not addressed the patient experience surrounding the surgical intervention such as pre-operative and post-operative care and communication. PURPOSE This study assesses the impact of outpatient superficial, deep, and partial parotid surgery on various parameters including surgical safety, distance traveled for care, utilization of telehealth, and patient-initiated communication. MATERIALS AND METHODS Retrospective study from January 2020 to October 2021. Patients undergoing superficial lobe, deep lobe, and partial parotidectomies for benign and malignant pathologies were divided into inpatient and outpatient cohorts. A multivariable model examined the relationship between admission status and surgical complications, adjusted for age, sex, and tumor size. RESULTS 159 patients total, 94 outpatient and 65 inpatients. No statistical difference in rates of surgical complications with the exception of salivary leak. There was an increased rate of salivary leak reported in the inpatient group (OR 5.4, 95 % CI 1.6 to 18.0, p = 0.01). Mean patient travel distance of 354 miles one-way. Post-operatively, 76 % were evaluated via video visit. Following discharge, >55 % of patients initiated communication with the surgical team, which was not statistically different between the groups. CONCLUSIONS Outpatient parotidectomy is safe and can be more convenient, but telehealth communication must be balanced with rigorous attention to patient education.
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Affiliation(s)
- Emily E Karp
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Linda X Yin
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | | | - Thomas J O'Byrne
- Mayo Clinic Department of Quantitative Health Sciences, Rochester, MN, USA
| | | | - Kendall K Tasche
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Kathryn M Van Abel
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Jan L Kasperbauer
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Eric J Moore
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA
| | - Daniel L Price
- Mayo Clinic Department of Otolaryngology Head & Neck Surgery, Rochester, MN, USA.
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De Ravin E, Armache M, Campbell F, Rising KL, Worster B, Handley NR, Fundakowski CE, Cognetti DM, Mady LJ. Feasibility and Cost of Telehealth Head and Neck Cancer Survivorship Care: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:1312-1323. [PMID: 36939546 DOI: 10.1002/ohn.213] [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: 08/19/2022] [Revised: 10/28/2022] [Accepted: 11/12/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Evaluate the feasibility and cost-effectiveness of telehealth head and neck cancer (HNC) survivorship care. DATA SOURCES Ovid MEDLINE, Embase, Scopus, CINAHL. REVIEW METHODS A systematic search for peer-reviewed feasibility studies on telehealth models for HNC survivorship care published between 2005 and 2021 was conducted using the terms "head and neck cancer" and "telehealth" and their synonyms. Inclusion criteria were studies on telehealth survivorship program interventions for HNC patients with quantitative feasibility outcome measures (eg, enrollment, retention, attrition/dropout rate, adherence/task completion rate, patient satisfaction, cost). RESULTS Thirty-eight studies out of 1557 identified met inclusion criteria and were included for analysis. Feasibility outcomes evaluated were enrollment and attrition rates, adherence/task completion rates, patient satisfaction, and user feedback surveys in different survivorship domains. Patient enrollment ranged from 20.8% to 85.7%, while attrition ranged from 7% to 47.7%. Overall, adherence was 30.2% higher in the intervention group than in the control group (46.8% vs 16.6%). Studies with cost analysis found telehealth models of care to be statistically significantly less expensive and more cost-efficient than the standard model of care, with a $642.30 saving per patient (n = 3). Telehealth models also substantially reduced work time saving per visit (on average, 7 days per visit). CONCLUSION While telehealth survivorship programs are feasible and cost-effective and are associated with improved patient outcomes, they might not be ideal for every patient. Further investigations are needed to understand the role of telehealth in survivorship care, given the variability in study design, reporting, measures, and methodological quality.
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Affiliation(s)
- Emma De Ravin
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Armache
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Frank Campbell
- Penn Libraries, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin L Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brooke Worster
- Department of Hospice and Palliative Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nathan R Handley
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leila J Mady
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gwilt C, Metzger G, Jatana K, Bourgeois T, Walz P. Perceptions of telemedicine at a pediatric otolaryngology-head and neck surgery program. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000440. [DOI: 10.1136/wjps-2022-000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
ObjectiveWith few studies investigating the effectiveness of telemedicine (TM) in pediatric otolaryngology (ear, nose, and throat; ENT), its role in clinical practice is unclear. The objective of this study was to investigate provider perspectives regarding utility of TM in pediatric ENT practice.MethodsA survey gauging the relative merits of TM visits for common pediatric ENT chief complaints and postoperative visits was distributed to all pediatric ENT providers at a tertiary care, free-standing children’s hospital. Respondents were asked to assess the effectiveness of TM visits compared with in-person visits for completing the following tasks: history collection, physical examination, medical decision-making, and patient counseling.ResultsProviders rated TM visits as less useful than in-person visits for completing the most predefined tasks but did identify advantages in history taking via TM for the majority of complaints. Compared with providers with ≥10 years of experience, those with <10 years of experience found TM to be more effective than the in-person appointment for making clinical decisions for patients presenting with recurrent/chronic pharyngitis, neck masses, and stridor/noisy breathing. Opinions regarding the utility of TM for postoperative visits were mixed, with adenoidectomy, tonsillectomy and superficial procedures being most frequently deemed appropriate for TM.ConclusionsThe introduction of TM to pediatric ENT faces limitations in detailed examination of areas not accessible without specialized instrumentation. Due to its strength in history taking, results suggest an asynchronous, ‘store and forward’ encounter followed by an in-person physical examination to confirm the diagnosis and treatment plan could be beneficial.
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Jones JW, Saravia A, Mamidi IS, Torres JI, Evans AK. Telehealth Adoption and Perspectives Among Pediatric Otolaryngologists Following the COVID-19 Pandemic. Ann Otol Rhinol Laryngol 2022:34894221129014. [PMID: 36217956 DOI: 10.1177/00034894221129014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess use of and physician experiences with pediatric otolaryngology telehealth visits as impacted by the COVID-19 pandemic. STUDY DESIGN/SETTING Cross sectional survey. METHODS A 15-question survey was electronically distributed to 656 members of the American Society of Pediatric Otolaryngology in August 2021, addressing member demographics, experiential practice elements, and use pre-pandemic, during the initial shutdown period of March-May 2020, and current use at the time of survey inquiry. RESULTS There were 124 respondents (response rate = 18.9%). Incident use pre-pandemic and during the shutdown were 21.0% (n = 26), and 92.7% (n = 115), respectively. Current use was 83.9% (n = 104) and the percentage of new current users (79.5%, n = 78) was significant (P < .0001,95% CI = 70.6%-86.4%). Estimated median telehealth visit rates pre-pandemic, during shutdown, and currently were 0 to 1, 4 to 5, and 2 to 3 per week, respectively (P < .0001). A difference in post-covid adoption rates was noted only for location (P = .008), with no differences for years out of training or practice type. Compared to in-person visits, physician satisfaction with telehealth visits was rated equivalent (49.0%) or worse/much worse (48.1%). The most common telehealth uses were follow-up visits (83.7%), pre-operative counseling (76.9%), and post-operative evaluation (69.2%). The need for a detailed exam (89.4%) and initial visits (32.7%) were reasons a telehealth visit was not offered. CONCLUSIONS The COVID-19 pandemic appears to have precipitated a rapid increase in telehealth adoption among surveyed pediatric otolaryngologists, regardless of age or practice type. The most significant limitations remain the need for a detailed exam, perceived low patient technological literacy, and limitations to interpretive services. Technology-based optimization of these barriers could lead to increased use and physician satisfaction.
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Affiliation(s)
- Joel W Jones
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ari Saravia
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ishwarya S Mamidi
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jairo I Torres
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Adele K Evans
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Tolvi M, Lahti T, Aaltonen LM. Otorhinolaryngology Virtual Visits During the COVID-19 Pandemic: A 2-Year Follow-Up Study. Telemed J E Health 2022; 29:665-673. [PMID: 36112177 DOI: 10.1089/tmj.2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To clarify how successful virtual visits were in different age groups and subspecialties of otorhinolaryngology during the COVID-19 pandemic, with a 2-year follow-up. Methods: We examined the progress of treatment and need for face-to-face follow-ups in a retrospective setting. Case records of all the visits marked as virtual between March and June 2020 in Helsinki University Hospital Department of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) were reviewed. Results: Among 865 virtual visits, 71.2% (n = 616) clearly advanced treatment, 53.8% (n = 465) needed no face-to-face follow-up, and only 9.0% (n = 78) were followed by an unplanned visit within 6 months. Statistically significant differences were detected among different subspecialties and age groups. Virtual visits achieved clear progress of treatment most frequently in laryngology (119/149 visits, 79.9%) and in head and neck surgery (69/83 visits, 83.1%). Laryngology patients required the least face-to-face follow-ups (n = 38 scheduled, 25.5% of laryngology visits). Most visits with clear progress involved 18-29-year-olds (n = 100, 80.0%) and they also required least face-to-face follow-ups (n = 39, 31.2%). During the 6-month to 2-year follow-up, 82 patients (9.6%) contacted our clinic directly for outpatient treatment, 28 patients (3.3%) called or visited the emergency department, and 37 patients (4.3%) were referred to the ORL-HNS clinic again for the same issue. Conclusion: Virtual visits were beneficial for treatment of otorhinolaryngology patients, and unplanned visits afterward were rare. Differences in effectiveness among subspecialties suggest that the utility of telemedicine applications can be enhanced by examining more closely which patient and ailment characteristics favor virtual visits.
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Affiliation(s)
- Morag Tolvi
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Tiitu Lahti
- Department of Otorhinolaryngology—Head and Neck Surgery, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
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Choi JS, Lin M, Park S, Abdur-Rahman F, Kim JH, Voelker CCJ. Physician satisfaction with telemedicine and in-person visits in otolaryngology. Am J Otolaryngol 2022; 43:103596. [PMID: 35969912 DOI: 10.1016/j.amjoto.2022.103596] [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: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To investigate the differential factors associated with physician satisfaction between telemedicine and in-person visits in otolaryngology. METHODS Study data included 646 telemedicine and 365 in-person encounters delivered from May-June 2020 at a tertiary center outpatient setting. Encounter-specific physician satisfaction was rated by 15 otolaryngologists using Provider Satisfaction Questionnaire (range 0-100) consisted of 5 items (patient needs addressed, patient involvement, adequacy of information given, quality of emotion support provided, and general interaction satisfaction). A multivariable linear mixed-effects model was used to explore patient demographic and clinical factors associated with physician satisfaction. RESULTS Physician satisfaction scores for telemedicine and in-person visits were 83.0 [95 % CI: 77.0-88.9] and 88.1 [95 % CI: 82.5-93.6], respectively. Among telemedicine visits, physician satisfaction scores were significantly higher for follow-up (vs. new), videoconference (vs. telephone) encounters, and English-speaking patients in a multivariable model. New encounters had significantly lower satisfaction subdomain scores for adequacy of information given to the patient (β = -4.7 [95 % CI: -7.3 to -2.0], p = 0.001) and addressing the needs of the patient among telemedicine visits (β = -4.1, [95 % CI: -7.1 to -1.1], p = 0.007) while there were no differences in satisfaction scores between new vs follow-up visits among in-person visits. For non-English speaking patients, the physician satisfaction scores were significantly lower for subdomain scores assessing active patient participation (β = -13.1, [95 % CI: -13.1 to -17.4], p < 0.001) and emotional support given to the patient (β = -7.8, [95 % CI: -11.0 to -4.5], p < 0.001) for telemedicine visits. CONCLUSIONS Telemedicine has been broadly adopted as an alternative option to deliver care in otolaryngology since COVID-19 pandemic. Appropriate triaging based on patient and encounter characteristics may enhance physician satisfaction and overall experiences with telemedicine. Further efforts are needed to provide adequate interpretation and videoconference services during telemedicine visits.
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Affiliation(s)
- Janet S Choi
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, MN, USA.
| | - Matthew Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Soyun Park
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Faiz Abdur-Rahman
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - James H Kim
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck, School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Dhillon K, Manji J, Tapia Céspedes M, Prasad J, Kleid S, Flatman S, Nguyen K, McLean T, Magarey M. Use of telemedicine consultations in head and neck cancer: patient perceptions, acceptability and accessibility. ANZ J Surg 2022; 92:1415-1422. [PMID: 35490336 DOI: 10.1111/ans.17722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUNDS Telemedicine has been effective in the management of various medical conditions, however, there is limited knowledge of its use in head and neck oncosurveillance. This is of importance currently while trying to mitigate the risk of transmission during the COVID-19 pandemic. This study aims to evaluate acceptability, satisfaction and perceptions of telemedicine technology among outpatients for head and neck oncologic surveillance. METHODS A cross-sectional study was conducted for head and neck surgical oncology patients who attended telemedicine consultations between March and October 2020 at the Peter MacCallum Cancer Centre. Data on demographic, socioeconomic and acceptability variables was collected, utilizing Likert scale questions. The primary outcome measures were patient satisfaction and perceptions, while the secondary outcome was access to technology. RESULTS One hundred and fifteen patients were invited to participate, and 100 were included in the final analysis; 95% of patient's had a positive experience with telemedicine appointments and were willing to have future telemedicine appointments. Regional and rural patients were more accepting of telemedicine consultations, citing savings in travel time and the minimal disruption to normal day-to-day activities. All participants had access to telecommunication devices, with 63% having three or more devices. Issues identified include a lack of physical examination by clinician for 65% of participants and the inability to self-examine for 88% of participants. CONCLUSION The study demonstrates patients' acceptance of telemedicine appointments as a component of outpatient surveillance for head and neck surgical oncology. This has benefits during the COVID-19 pandemic in addition to increasing accessibility for rural patients.
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Affiliation(s)
- Kaman Dhillon
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jamil Manji
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mario Tapia Céspedes
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jessica Prasad
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen Kleid
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Samuel Flatman
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kevin Nguyen
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Timothy McLean
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Matthew Magarey
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
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Evaluation of the Use of Telehealth Video Visits for Veterans With Chronic Pain. Pain Manag Nurs 2022; 23:418-423. [PMID: 35331651 PMCID: PMC8934702 DOI: 10.1016/j.pmn.2022.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/29/2021] [Accepted: 02/06/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Telehealth video visits are essential for delivering timely care while mitigating exposure during the COVID-19 pandemic. Telehealth video visits have the potential to improve missed appointments, reduce costs associated with Veterans Affairs (VA) travel reimbursement, and lead to positive patient and provider satisfaction. AIMS This evidence-based improvement project sought to evaluate whether telehealth visits reduce the occurrence of missed appointments, determine cost savings associated with the VA travel reimbursement and assess patient and provider satisfaction with telehealth video visits. DESIGN Evidence-based improvement project. SETTING A retrospective chart review was conducted on military veterans with chronic pain who completed a telehealth video visit in the VA San Diego (VASD) pain clinic. METHODS Missed appointment rates were compared from before (April 1, 2019-October 1, 2019) to after (April 1, 2020-October 1, 2020) implementation of the telehealth video visits. Estimated travel reimbursement for qualified patients was calculated per VA policy. Electronic satisfaction surveys were administered to patients and nurse practitioners to assess satisfaction with telehealth video visits. RESULTS There was an 82.5% reduction in missed appointments from pre to post implementation of telehealth video visits. There was an estimated cost savings in travel reimbursements of $3,308.30. Overall, 93.62% of patients (n = 42) were satisfied with their video visits and there was a high degree of satisfaction in implementing video visits among the nurse practitioners (n = 3). CONCLUSIONS The use of telehealth video visits during the COVID-19 pandemic reduced missed appointments, exhibited cost savings in VA travel reimbursement, and led to positive patient and provider satisfaction.
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