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Montalbaron MB, Achlatis E, Johnson AM, Ma Y, Young VN, Rosen CA, Amin MR, Kwak PE. Presumptive Diagnosis in Tele-Health Laryngology: A Multi-Center Observational Study. Ann Otol Rhinol Laryngol 2023; 132:1511-1519. [PMID: 37070580 DOI: 10.1177/00034894231165811] [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: 04/19/2023]
Abstract
OBJECTIVES Early in the COVID-19 pandemic, outpatient visits were adapted for the virtual setting, forcing laryngologists to presume certain diagnoses without the aid of laryngoscopy, solely based on history and the limited physical exam available via video visit. This study aims to examine the accuracy of presumptive diagnoses made via telemedicine, compared to subsequent in-person follow up, where endoscopic examination could confirm or refute suspected diagnoses. METHODS A retrospective chart review was conducted of 38 patients evaluated for voice-related issues at NYU Langone Health and the University of California-San Francisco. Presumptive diagnoses at the initial telemedicine encounter were noted, along with diagnostic cues used for clinical reasoning and recommended treatment plans. These presumptive diagnoses were compared to diagnoses and plans established following laryngoscopy at follow-up in-person visits. RESULTS After laryngoscopy at the first in-person visit, 38% of presumptive diagnoses changed, as did 37% of treatment plans. The accuracy varied among conditions. Muscle tension dysphonia and Reinke's edema were accurately diagnosed without laryngoscopy, but other conditions, including vocal fold paralysis and subglottic stenosis, were not initially suspected, relying on laryngoscopy for diagnosis. CONCLUSIONS While some laryngologic conditions may be reasonably identified without in-person examination, laryngoscopy remains central to definitive diagnosis and treatment. Telemedicine can increase access to care, but it may provide more utility as a screening tool, triaging which patients should present more urgently for in-person laryngoscopy. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Michael B Montalbaron
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Efstratios Achlatis
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Aaron M Johnson
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Yue Ma
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - VyVy N Young
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Clark A Rosen
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Paul E Kwak
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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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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Yang A, Kim D, Hwang PH, Lechner M. Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review. OTO Open 2022; 6:2473974X211072791. [PMID: 35274073 PMCID: PMC8902203 DOI: 10.1177/2473974x211072791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Telemedicine and telementoring have had a significant boost across
all medical and surgical specialties over the last decade and
especially during the COVID-19 pandemic. The aim of this scoping
review is to synthesize the current use of telemedicine and
telementoring in otorhinolaryngology and head and neck
surgery. Data Sources PubMed and Cochrane Library. Review Methods A scoping review search was conducted, which identified 469
articles. Following full-text screening by 2 researchers, 173
articles were eligible for inclusion and further categorized via
relevant subdomains. Conclusions Virtual encounters and telementoring are the 2 main applications of
telemedicine in otolaryngology. These applications can be
classified into 7 subdomains. Different ear, nose, and throat
subspecialties utilized certain telemedicine applications more
than others; for example, almost all articles on patient
engagement tools are rhinology based. Overall, telemedicine is
feasible, showing similar concordance when compared with
traditional methods; it is also cost-effective, with high
patient and provider satisfaction. Implications for Practice Telemedicine in otorhinolaryngology has been widely employed during
the COVID-19 pandemic and has a huge potential, especially with
regard to its distributing quality care to rural areas. However,
it is important to note that with current exponential use, it is
equally crucial to ensure security and privacy and integrate
HIPAA-compliant systems (Health Insurance Portability and
Accountability Act) in the big data era. It is expected that
many more applications developed during the pandemic are here to
stay and will be refined in years to come.
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Affiliation(s)
- Angela Yang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Dayoung Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Peter H. Hwang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Matt Lechner
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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Jin ML, Brown MM, Patwa D, Nirmalan A, Edwards PA. Telemedicine, telementoring, and telesurgery for surgical practices. Curr Probl Surg 2021; 58:100986. [PMID: 34895561 DOI: 10.1016/j.cpsurg.2021.100986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Man Li Jin
- Resident in Ophthalmology, Henry Ford Hospital, Detroit, MI.
| | - Meghan M Brown
- Medical Student, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Dhir Patwa
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Aravindh Nirmalan
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Paul A Edwards
- Chairman, Department of Ophthalmology, Henry Ford Hospital, Detroit, MI
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In Brief. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Choi JS, Kim JH, Park S, Lin M, Abdur-Rahman F, Mack WJ, Volker CCJ. Telemedicine in Otolaryngology During COVID-19: Patient and Physician Satisfaction. Otolaryngol Head Neck Surg 2021; 167:56-64. [PMID: 34491856 DOI: 10.1177/01945998211041921] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine patient and physician satisfaction with telemedicine in otolaryngology during COVID-19 and identify associated factors. STUDY DESIGN Prospective cohort study. SETTING Tertiary care center. METHODS Patient satisfaction was rated by patients (age ≥18 years) who had encounters from May to July 2020 (n = 407). Physician satisfaction was rated by 15 otolaryngologists for specific encounters delivered from May to June 2020 (n = 1011). Patient satisfaction was measured with a Press Ganey questionnaire and a Telemedicine Satisfaction Questionnaire. Mean Press Ganey satisfaction scores of telemedicine encounters during COVID-19 were compared with the pre-COVID-19 Press Ganey scores from in-person encounters (n = 3059) to test a noninferiority hypothesis. Physician satisfaction was measured with a Provider Satisfaction Questionnaire. RESULTS The mean Press Ganey patient satisfaction score for telemedicine encounters was 94.5 (SD, 8.8), no worse than that for in-person encounters prior to COVID-19 at 93.7 (SD, 15.5; Δ = 0.8 [95% CI, -0.5 to 2.1, excluding the noninferiority margin of -1]). Encounters with videoconference (vs telephone) and patients reporting higher income were associated with higher Telemedicine Satisfaction Questionnaire scores. Physician satisfaction scores during COVID-19 with telemedicine encounters were overall high at 83.3 (95% CI, 77.5-89.1), slightly lower when compared with the scores with in-person encounters at 88.4 (95% CI, 82.5-94.3; Δ = -5.2 [95% CI, -6.6 to -3.8]). Encounters with videoconference (vs telephone) and patients with English as a preferred language and follow-up visits were associated with higher Provider Satisfaction Questionnaire scores. CONCLUSIONS Telemedicine is a feasible alternative format in otolaryngology during COVID-19 with overall high patient and physician satisfaction. Patient satisfaction with telemedicine encounters during COVID-19 was no worse than in-person encounters prior to the pandemic. Physician satisfaction with telemedicine was relatively lower in comparison with in-person encounters.
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Affiliation(s)
- Janet S Choi
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - James H Kim
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Soyun Park
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Matthew Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Faiz Abdur-Rahman
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Wendy J Mack
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Courtney C J Volker
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Tan NG, Yang LWY, Tan MZW, Chng J, Tan MHT, Tan C. Virtual care to increase military medical centre capacity in the primary health care setting: A prospective self-controlled pilot study of symptoms collection and telemedicine. J Telemed Telecare 2020; 28:603-612. [PMID: 33016187 DOI: 10.1177/1357633x20959579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The Singapore Armed Forces (SAF) recognises the potential benefits and looks to harnessing telemedicine for primary health care services. In this prospective self-controlled pilot study, we aimed to evaluate the safety, efficiency and user satisfaction outcomes of virtual care (VC) at a military medical centre. METHODS Out of 320 patients seen during the study period, 28 were enrolled in this study and underwent on-premises VC, comprising digital symptoms collection and telemedicine in addition to the usual in-person physician consultation. Safety outcomes were measured based on the diagnostic concordance between physicians. Efficiency was measured based on consultation times, and user satisfaction was evaluated using a standard questionnaire. RESULTS There was a higher caseload of both upper respiratory infections and dermatological conditions in our population, in which telemedicine performed well. In terms of safety, telemedicine achieved a mean diagnostic concordance of 92.8% compared to in-person consultations. In terms of efficiency, consultation times were 26.2% - or 2 minutes and 15 seconds - shorter on average with telemedicine (p = 0.0488). User satisfaction was favourable, with 85.5% of patients satisfied with the VC experience. DISCUSSION This study has been invaluable in showing that on-premises telemedicine is a safe, efficient and effective means to extend and increase our surge capacity for primary health care. Our results have given us reasonable confidence to explore a larger-scale implementation in our network of military medical centres in the future.
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Affiliation(s)
| | | | | | | | | | - Clive Tan
- Singapore Armed Forces Medical Corps, Singapore
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Ning AY, Cabrera CI, D'Anza B. Telemedicine in Otolaryngology: A Systematic Review of Image Quality, Diagnostic Concordance, and Patient and Provider Satisfaction. Ann Otol Rhinol Laryngol 2020; 130:195-204. [PMID: 32659100 DOI: 10.1177/0003489420939590] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Telemedicine allows for the remote delivery of patient care and has been found to have a wide range of uses in otolaryngology. In order to achieve best practices in telemedicine, a platform must be effective and both patients and providers must be satisfied with the use of technology. As telemedicine becomes more widely used in otolaryngology clinics, particularly in the face of the current COVID-19 pandemic, it is important to assess its applicability in this field. The goal of this study was to evaluate existing literature on telemedicine and assess overall image quality, diagnostic concordance, and patient and provider satisfaction with telemedicine technologies. METHODS A systematic review was conducted on PubMed and MEDLINE according to the PRISMA 2009 guidelines for articles from 1982 to 2019 relating to telemedicine in otolaryngology. English language studies with primary or secondary endpoints pertaining to image quality, diagnostic concordance, or patient or provider satisfaction were included. Descriptive studies, editorials, and literature reviews were excluded. RESULTS A total of 32 studies were included in our review. Studies assessing imaging quality and diagnostic concordance reported adequate results but with some heterogeneity. Patient and provider satisfaction were consistently high. CONCLUSIONS The literature supports telemedicine delivery of otorhinolaryngologic care as having achieved high rates of patient and provider satisfaction with adequate image quality and heterogeneity in diagnostic concordance. Variability in diagnostic accuracy was reported, but appears improved given proper clinical context. More standardized studies are needed specific to telemedicine in the field of otolaryngology.
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Affiliation(s)
- Anne Y Ning
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brian D'Anza
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Layfield E, Triantafillou V, Prasad A, Deng J, Shanti RM, Newman JG, Rajasekaran K. Telemedicine for head and neck ambulatory visits during COVID-19: Evaluating usability and patient satisfaction. Head Neck 2020; 42:1681-1689. [PMID: 32476228 PMCID: PMC7300847 DOI: 10.1002/hed.26285] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In light of the COVID-19 pandemic, there has been a rapid increase in telemedicine visits. Otolaryngology patient satisfaction with these visits has not yet been extensively studied using a validated survey. METHODS All patients who had telemedicine visits with three head and neck surgeons, by phone or video-based platform, between March 25, 2020 and April 24, 2020. Retrospective chart reviews were conducted to determine demographic, disease, and treatment information. Patients who had a video visit were contacted by telephone and, if they could be reached and consented, were administered the telehealth usability questionnaire (TUQ). RESULTS Hundred surveys were completed. The average score across all questions was 6.01 on a scale from 1 to 7, where 7 indicated the highest level of patient agreement. The highest scores were for questions related to satisfaction with telehealth (6.29), while the lowest were related to reliability (4.86). CONCLUSIONS Patients are generally highly satisfied with telemedicine.
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Affiliation(s)
- Eleanor Layfield
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vasiliki Triantafillou
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jie Deng
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rabie M Shanti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
Context: Considering the pivotal role of telemedicine in providing healthcare services for remote areas, some of the military medical centers, especially in developed countries, use different types of telemedicine programs. Objectives: The present study aimed at identifying the implemented telemedicine projects in military medicine worldwide and introducing their features. Evidence Acquisition: The current systematic review was performed in 2018. PubMed, Scopus, Embase, and Web of Science databases were searched for articles published from 2014 to 2018 by a combination of related keywords, and the related original articles were then selected based on the inclusion and exclusion criteria. Data were collected by a data extraction form, and then the data were summarized and reported based on the study objectives. Results: Of the 173 articles retrieved from the first round of search, 12 were included in the study; five (41.66%) studies had used the synchronous (real-time telemedicine) method. The United States, with nine studies, had the highest number of projects in military telemedicine. Most studies (n = 7) were performed on tele-psychology and the application of telemedicine in psychology. All selected studies reported the positive effects of telemedicine on providing healthcare for military forces. Conclusions: The proper utilization of telemedicine equipment is effective in saving time for both patients and healthcare providers, reducing costs, supporting in natural disasters, and satisfying patients with military medicine. To achieve telemedicine program objectives, they should be set precisely. Considering the importance of timely healthcare services, it is suggested to utilize synchronous methods and tools such as video conferencing.
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Yulzari R, Bretler S, Avraham Y, Sharabi-Nov A, Even-Tov E, Gilbey P. Mobile Technology-Based Real-Time Teleotolaryngology Care Facilitated by a Nonotolaryngologist Physician in an Adult Population. Ann Otol Rhinol Laryngol 2017; 127:46-50. [PMID: 29182011 DOI: 10.1177/0003489417745089] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Telehealth can improve access to specialist care. Very few reports of the use of smartphones for teleotolaryngology exist. The objective of this study is to evaluate the use of mobile teleotolaryngology facilitated by a nonotolaryngologist physician. METHODS A prospective study in adult patients attending a general otolaryngology outpatient clinic. The telehealth encounter with a remote otolaryngologist was facilitated by a final-year medical student simulating a general physician prior to the scheduled visit. The patient and the remote otolaryngologist rated their satisfaction with the encounter. The remote otolaryngologist formulated a diagnosis and rated the level of certainty of this diagnosis. Diagnoses from the telehealth encounter and the face-to-face encounter were compared. RESULTS Forty-eight patients with an average age of 42.5 years participated in this study. In 79.2% of the consultations, there was concordance between the diagnoses. The average patient and remote otolaryngologist satisfaction with the encounter was 9.5 ± 0.9 and 8.7 ± 1.3, respectively. Twenty-four of the 48 visits (50%) were defined as unnecessary. In the otology group, concordance rates and rates of preventable visits were highest. CONCLUSIONS Synchronous telehealth consultations, facilitated by a general physician, can be an alternative to visiting a general otolaryngology clinic, especially for otologic patients.
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Affiliation(s)
- Raphael Yulzari
- 1 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Shlomi Bretler
- 1 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Yaniv Avraham
- 2 Otolaryngology, Head & Neck Surgery Unit, Ziv Medical Center, Safed, Israel
| | - Adi Sharabi-Nov
- 3 Research Wing, Ziv Medical Center, Safed, Israel and Tel-Hai Academic College, Tel-Hai, Israel
| | - Ella Even-Tov
- 1 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,2 Otolaryngology, Head & Neck Surgery Unit, Ziv Medical Center, Safed, Israel
| | - Peter Gilbey
- 1 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Osma-Ruiz V, Godino-Llorente J, Sáenz-Lechón N, Gutiérrez-Arriola J, Arias-Londoño J, Fraile R, Scola-Yurrita B. Towards collaborative work among speech therapists, phoniatricians, and ENT professionals: Analysis of the impact of ciphering techniques in the performance of an integrated tool for the diagnosis of voice disorders. Biomed Signal Process Control 2012. [DOI: 10.1016/j.bspc.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Xu CQ, Smith AC, Scuffham PA, Wootton R. A cost minimisation analysis of a telepaediatric otolaryngology service. BMC Health Serv Res 2008; 8:30. [PMID: 18241356 PMCID: PMC2270267 DOI: 10.1186/1472-6963-8-30] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 02/04/2008] [Indexed: 01/18/2023] Open
Abstract
Background Paediatric ENT services in regional areas can be provided through telemedicine (tele-ENT) using videoconferencing or with a conventional outpatient department ENT service (OPD-ENT) in which patients travel to see the specialist. The objective of this study was to identify the least-cost approach to providing ENT services for paediatric outpatients. Methods A cost-minimisation analysis was conducted comparing the annual costs of the two modes of service provided by the Royal Children's Hospital (RCH) in Brisbane. Activity records were reviewed to analyse volume of activity during a 12 month period in 2005, i.e. number of clinics, duration of clinics, number of consultations via telemedicine and in outpatient clinics, diagnoses, and travel related information. A sensitivity analysis was conducted using factors where there was some uncertainty or potential future variation. Results During the study period, 88 ENT consultations were conducted via videoconference for 70 patients at Bundaberg Base Hospital. 177 ENT consultations were conducted at the RCH for 117 patients who had travelled from the Bundaberg region to Brisbane. The variable cost of providing the tele-ENT service was A$108 per consultation, compared with A$155 per consultation for the conventional outpatient service. Telemedicine was cheaper when the workload exceeded 100 consultations per year. If all 265 consultations were conducted as tele-ENT consultations, the cost-savings would be $7,621. Conclusion The cost-minimisation analysis demonstrated that under the circumstances described in this paper, the tele-ENT service was a more economical method for the health department of providing specialist ENT services.
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Affiliation(s)
- Cathy Q Xu
- Centre for Online Health, University of Queensland, Level 3 Foundation Building, Royal Children's Hospital, Herston, Queensland 4029, Australia.
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15
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Smith AC, Williams J, Agnew J, Sinclair S, Youngberry K, Wootton R. Realtime telemedicine for paediatric otolaryngology pre-admission screening. J Telemed Telecare 2006; 11 Suppl 2:S86-9. [PMID: 16375809 DOI: 10.1258/135763305775124821] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a feasibility study to examine whether a paediatric patient at a regional hospital could be assessed by an ear, nose and throat (ENT) specialist via videoconference, therefore saving at least one journey to the tertiary hospital for a pre-admission appointment. A video-otoscope was used with standard videoconference equipment, and realtime images were transmitted at a bandwidth of 384 kbit/s. In all, 13 telepaediatric ENT clinics were conducted between November 2003 and April 2005, and 98 consultations were facilitated for 64 patients. The main reasons for referral were recurrent tonsillitis (25%) and obstructive sleep apnoea (23%). Of the 64 patients examined by telemedicine, 42 (66%) were recommended for surgery and placed on the surgical waiting list. About 12 patients (19%) required travel to the tertiary centre for further investigations and tests not available locally, while four patients (6%) were reviewed via videoconference during a scheduled clinic. Six patients (9%) required no further follow-up after their initial telepaediatric consultation. Videoconferencing is an effective method of assessing ENT conditions of paediatric patients and for pre-screening potential surgical admissions to a tertiary hospital. Careful consideration of a number of economic and logistical factors needs to be made before large investments are made to expand the service.
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Affiliation(s)
- Anthony C Smith
- Centre for Online Health, University of Queensland, Australia.
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