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Usher K, Williams J, Jackson D. The potential of virtual healthcare technologies to reduce healthcare services' carbon footprint. Front Public Health 2024; 12:1394095. [PMID: 38818441 PMCID: PMC11137209 DOI: 10.3389/fpubh.2024.1394095] [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] [Received: 03/01/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
The COVID-19 pandemic demonstrated the potential to reduce our carbon footprint especially by reducing travel. We aim to describe healthcare and health education services' contribution to the global climate emergency and identify the need for increased use of virtual health service delivery and undergraduate/postgraduate education to help reduce the impact of health service and health education delivery on the environment. Health care services, as one of the largest contributors to carbon emissions, must take steps to rapidly reduce their carbon footprint. Health services have unfortunately paid little attention to this issue until recently. Virtual healthcare and education have a valuable role in transition to a net carbon-zero outcome. Given the increasing use of and satisfaction with virtual health services such as telehealth, and the increase in virtual education opportunities, it is important that a concerted effort is undertaken to increase their use across health services and education in the future.
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Affiliation(s)
- Kim Usher
- Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
- New England Virtual Health Network (NEViHN), Armidale, NSW, Australia
| | - Jen Williams
- Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
- New England Virtual Health Network (NEViHN), Armidale, NSW, Australia
| | - Debra Jackson
- School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Makarewich CA, Cheminant JR, Biddle NC, Brennan JN, San Juan A. Telehealth follow-up in the postoperative care of surgically treated pediatric supracondylar humerus fractures. J Pediatr Orthop B 2024; 33:192-197. [PMID: 37129024 DOI: 10.1097/bpb.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Supracondylar humerus fractures are a common pediatric orthopedic injury requiring surgery. These patients are typically seen 4 weeks post-op for cast and pin removal followed by an 8-12-week post-op motion check. Our study aimed to limit the number of in-office visits by conducting this last motion check by telehealth. This was a single-surgeon series of consecutive surgically treated supracondylar humerus fractures. The primary outcome was the number of patients who completed their range of motion check remotely. Loss to follow-up at the telehealth visit was compared to a prior cohort for whom the range of motion visit was performed in person. Secondary outcomes included number of patients missing work/school for the in-person vs. telehealth visits and satisfaction with the in-person and telehealth visits. Twenty-two patients were enrolled during the study period. Sixteen (73%) successfully completed their telehealth follow-up, which was similar to the prior in-person cohort. Significantly more parents/children had to take a day off from work/school to attend the in-person visit. No patient required a subsequent in-person visit or referral to physical therapy. A total of 100% of patients reported excellent satisfaction with their telehealth visit. Overall satisfaction was similar comparing the in-person vs. telehealth visits (84% vs. 100% reporting excellent satisfaction, P = 0.12). Telehealth is a viable option for the postoperative care of surgically treated supracondylar humerus fractures. This approach limits in-office visits and decreases the need for parents/children to miss work/school while maintaining excellent satisfaction scores.
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Affiliation(s)
- Christopher A Makarewich
- Department of Orthopaedics, University of Utah
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Jenna R Cheminant
- Department of Orthopaedics, University of Utah
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Nicholas C Biddle
- Department of Orthopaedics, University of Utah
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Jayden N Brennan
- Department of Orthopaedics, University of Utah
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Angielyn San Juan
- Department of Orthopaedics, University of Utah
- Primary Children's Hospital, Salt Lake City, Utah, USA
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Rodler S, Ramacciotti LS, Maas M, Mokhtar D, Hershenhouse J, De Castro Abreu AL, Fuchs G, Stief CG, Gill IS, Cacciamani GE. The Impact of Telemedicine in Reducing the Carbon Footprint in Health Care: A Systematic Review and Cumulative Analysis of 68 Million Clinical Consultations. Eur Urol Focus 2023; 9:873-887. [PMID: 38036339 DOI: 10.1016/j.euf.2023.11.013] [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] [Received: 09/21/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT Carbon footprint (CF) has emerged as an important factor when assessing health care interventions. OBJECTIVE To investigate the reduction in CF for patients utilizing telemedicine. EVIDENCE ACQUISITION The PubMed, Scopus, and Web of Science databases were queried for studies describing telemedicine consultation and reporting on carbon emissions saved and the carbon emissions of telemedicine devices as primary outcomes, and travel distance and time and cost savings and safety as secondary outcomes. Outcomes were tabulated and calculated per consultation. Carbon emissions and travel distances were also calculated for each total study cohort. Risk of bias was assessed using the Newcastle-Ottawa scale, and the Oxford level of evidence was determined. EVIDENCE SYNTHESIS A total of 48 studies met the inclusion criteria, covering 68 465 481 telemedicine consultations and savings of 691 825 tons of CO2 emissions and 3 318 464 047 km of travel distance. Carbon assessment was mostly reported as the estimated distance saved using a conversion factor. Medical specialties used telemedicine to connect specialists with patients at home (n = 25) or at a local center (n = 6). Surgical specialties used telemedicine for virtual preoperative assessment (n = 9), follow-up (n = 4), and general consultation (n = 4). The savings per consultation were 21.9-632.17 min and $1.85-$325. More studies focused on the COVID-19 time frame (n = 33) than before the pandemic (n = 15). The studies are limited by calculations, mostly for the travel distance for carbon savings, and appropriate follow-up to analyze the real impact on travel and appointments. CONCLUSIONS Telemedicine reduces the CF of the health care sector. Expanding the use of telemedicine and educating providers and patients could further decrease CO2 emissions and save both money and time. PATIENT SUMMARY We reviewed 48 studies on the use of telemedicine. We found that people used their cars less and saved time and money, as well as CO2 emissions, if they used teleconsultations. Some studies only looked at how much CO2 from driving was saved, so there might be more to learn about the benefits of teleconsultations. The use of online doctor appointments is not only good for our planet but also helps patients in saving time and money. This review is registered on the PROSPERO database for systematic reviews (CRD42023456839).
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Affiliation(s)
- Severin Rodler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA; Department of Urology, University Hospital of LMU Munich, Munich, Germany
| | - Lorenzo Storino Ramacciotti
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Marissa Maas
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Daniel Mokhtar
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Jacob Hershenhouse
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Andre Luis De Castro Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Gerhard Fuchs
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Christian G Stief
- Department of Urology, University Hospital of LMU Munich, Munich, Germany
| | - Inderbir S Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
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Tenforde AS, Alexander JJ, Alexander M, Annaswamy TM, Carr CJ, Chang P, Díaz M, Iaccarino MA, Lewis SB, Millett C, Pandit S, Ramirez CP, Rinaldi R, Roop M, Slocum CS, Tekmyster G, Venesy D, Verduzco-Gutierrez M, Zorowitz RD, Rowland TR. Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research. PM R 2023; 15:1156-1174. [PMID: 37354209 DOI: 10.1002/pmrj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Joshua J Alexander
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Conley J Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Chang
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Stephen B Lewis
- Physiatry-Pharmacy Collaborative, NJ Institute for Successful Aging, Princeton, New Jersey, USA
| | - Carolyn Millett
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | | | | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Megan Roop
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Gene Tekmyster
- Department of Orthopedic Surgery, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network, Georgetown University, Washington, District of Columbia, USA
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Jungbauer WN, Gudipudi R, Brennan E, Melvin CL, Pecha PP. The Cost Impact of Telehealth Interventions in Pediatric Surgical Specialties: A Systematic Review. J Pediatr Surg 2023; 58:1527-1533. [PMID: 36379748 PMCID: PMC10121966 DOI: 10.1016/j.jpedsurg.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Telehealth is a rapidly expanding care modality in the United States. Pediatric surgical patients often require complex care which can incur significant expenses, some of which may be alleviated by telehealth. We performed a systematic review comparing telehealth and in-person visits, and telehealth's impacts on the cost of healthcare across pediatric surgical specialties. METHODS A systematic review was performed using the following databases: PubMed (MEDLINE), Scopus (Elsevier), and CINAHL (EBSCOHost), searched from inception to July 10th, 2022. Studies were included per the following criteria: (1) investigated a telehealth intervention for pediatric surgical care and (2) provided some metric of telehealth cost compared to an in-person visit. Non-English or studies conducted outside of the U.S. were excluded. RESULTS Fourteen manuscripts met inclusion criteria and presented data on 7992 visits, including patients with a weighted average age of 7.5 ± 3.5 years. Most (11/14) studies used telehealth in a synchronous, or "real-time" context. Of the studies which calculated dollar cost savings for telehealth visits compared to in-person appointments we found a substantial range of savings per visit, from $48.50 to $344.64. Cost savings were frequently realized in terms of reduced travel expenditures, lower opportunity costs (e.g. lost wages), and decreased hospital labor requirements. CONCLUSIONS This review suggests that telehealth provides cost incentives to pediatric surgical care in many scenarios, including post-operative visits and some routine clinic visits. Future work should focus on standardizing the metrics by which cost impacts are analyzed and detailing which visits are most appropriately facilitated by telehealth. LEVEL OF EVIDENCE V.
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Affiliation(s)
- W Nicholas Jungbauer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States
| | - Rachana Gudipudi
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States
| | - Emily Brennan
- Department of Research and Education Services, Medical University of South Carolina, Charleston, SC, United States
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States.
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Katchburian L. Clinician's Commentary on Chagas et al. 1. Physiother Can 2023; 75:92-93. [PMID: 37250738 PMCID: PMC10211376 DOI: 10.3138/ptc-2021-0006-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Affiliation(s)
- Lesley Katchburian
- Lead Clinical Specialist/Clinical Academic Physiotherapist in Neurodisability, The Wolfson Neurodisability Service, Great Ormond Street Hospital for Children/University College London Great Ormond Street Institute of Child Health, London, England, United Kingdom;
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Pickard Strange M, Booth A, Akiki M, Wieringa S, Shaw SE. The role of virtual consulting in developing environmentally sustainable healthcare: a systematic literature review (Preprint). J Med Internet Res 2022; 25:e44823. [PMID: 37133914 DOI: 10.2196/44823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Health systems globally need to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting (including video- and telephone-based consulting) is regarded as one means by which this might be achieved, largely through reduced patient travel. Little is currently known about the ways in which forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programs at scale that can support increased environmental sustainability. OBJECTIVE In this paper, we asked, What is the impact of virtual consulting on environmental sustainability in health care? and What can we learn from current evaluations that can inform future reductions in carbon emissions? METHODS We conducted a systematic review of published literature according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. We searched the MEDLINE, PubMed, and Scopus databases using key terms relating to "carbon footprint," "environmental impact," "telemedicine," and "remote consulting," using citation tracking to identify additional articles. The articles were screened, and full texts that met the inclusion criteria were obtained. Data on the approach to carbon footprinting reported reductions in emissions, and the opportunities and challenges associated with the environmental sustainability of virtual consultations were extracted into a spreadsheet, analyzed thematically, and theorized using the Planning and Evaluating Remote Consultation Services framework to consider the various interacting influences, including environmental sustainability, that shape the adoption of virtual consulting services. RESULTS A total of 1672 papers were identified. After removing duplicates and screening for eligibility, 23 papers that focused on a range of virtual consulting equipment and platforms across different clinical conditions and services were included. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel related to face-to-face appointments. The shortlisted papers used a range of methods and assumptions to determine carbon savings, reporting these using different units and across varied sample sizes. This limited the potential for comparison. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors (eg, patient suitability, clinical indication, and organizational infrastructure) influencing the adoption, use, and spread of virtual consultations and the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (eg, risk of missed diagnoses from virtual consultations that result in the need for subsequent in-person consultations or admissions). CONCLUSIONS There is overwhelming evidence that virtual consulting can reduce health care carbon emissions, largely through reducing travel related to in-person appointments. However, the current evidence fails to look at system factors associated with implementing virtual health care delivery and wider research into carbon emissions across the entire clinical pathway.
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Affiliation(s)
- Martha Pickard Strange
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Melissa Akiki
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- University of Oslo, Oslo, Norway
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Donald N, Irukulla S. Greenhouse Gas Emission Savings in Relation to Telemedicine and Associated Patient Benefits: A Systematic Review. Telemed J E Health 2022; 28:1555-1563. [PMID: 35446668 DOI: 10.1089/tmj.2022.0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Telemedicine is a rapidly expanding service in the digitization of health care systems. Recently emphasis has been placed on the decarbonization of health care systems with National and World Health Organization initiatives aimed at carbon neutrality toward the mid-21st century. This study investigates greenhouse gas emissions related to telemedicine, its potential role in achieving carbon neutrality and its role in determining policy. We further investigate patient benefits related to telemedicine. Methods: A systematic review was conducted of the PubMed, Medline, EMBASE, EMCARE, CINAHL, and HMIC databases. Eligibility of studies was determined by predefined criteria. Results: A total of 31 studies were identified totaling over 57,000 patients. Carbon savings ranged from 0.69 kg CO2e (carbon dioxide equivalent) to 893 kg CO2e per encounter. Distances saved also ranged from 6.1 to 3,386 km. Further analysis of 18 included studies was conducted for cost savings that ranged from €1.73 in fuel costs to over U.S. $900 in travel related expenses. Similarly, 15 included studies were analyzed for time savings, which ranged from 38 min to 24 h. Conclusions: There are substantial carbon savings to be made with telemedicine systems. Furthermore, there are substantial benefits to patients in terms of both time savings and cost savings. Rural and isolated communities or patients needing tertiary or quaternary care may be a particular cohort that might benefit disproportionally from telemedicine and is an area where the largest per capita emission savings can potentially be made.
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Affiliation(s)
- Neil Donald
- West Herts Teaching Hospitals NHS Trust, Watford, United Kingdom
| | - Shashi Irukulla
- Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, United Kingdom
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KUROWSKI BRADG, GREVE KELLY, BAILES AMYF, ZAHNER JANET, VARGUS-ADAMS JILDA, MCMAHON MARYA, ARONOW BRUCEJ, MITELPUNKT ALEXIS. Electronic health record and patterns of care for children with cerebral palsy. Dev Med Child Neurol 2021; 63:1337-1343. [PMID: 33768551 PMCID: PMC9037045 DOI: 10.1111/dmcn.14867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/12/2022]
Abstract
AIM To characterize the patterns of care of children with cerebral palsy (CP) in a tertiary healthcare system. METHOD Electronic health record data from 2009 to 2019 were extracted for children with CP. Machine learning hierarchical clustering was used to identify clusters of care. The ratio of in-person to care coordination visits was calculated for each specialty. RESULTS The sample included 6369 children with CP (55.7% males, 44.3% females, 76.2% white, 94.7% non-Hispanic; with a mean age of 8y 2mo [SD 5y 10mo; range 0-21y; median 7y 1mo]) at the time of diagnosis. A total of 3.7 million in-person visits and care coordination notes were identified across 34 specialties. The duration of care averaged 5 years 5 months with five specialty interactions and 21.8 in-person visits per year per child. Seven clusters of care were identified, including: musculoskeletal and function; neurological; high-frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care. Network analysis showed shared membership among several clusters. INTERPRETATION Coordination of care is a central element for children with CP. Medical informatics, machine learning, and big data approaches provide unique insights into care delivery to inform approaches to improve outcomes for children with CP. What this paper adds Seven primary clusters of care were identified: musculoskeletal and function; neurological; high-frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care. The in-person to care coordination visit ratio was 1:5 overall for healthcare encounters. Most interactions with care teams occur outside of in-person visits. The ratio of in-person to care coordination activities differ by specialty.
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Affiliation(s)
- BRAD G KUROWSKI
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;,Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - KELLY GREVE
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - AMY F BAILES
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;,Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, Cincinnati, OH
| | - JANET ZAHNER
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - JILDA VARGUS-ADAMS
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;,Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - MARY A MCMAHON
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;,Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - BRUCE J ARONOW
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, Cincinnati, OH;,Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - ALEXIS MITELPUNKT
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA.,Pediatric Rehabilitation, Department of Rehabilitation, Dana-Dwek Children’s Hospital, Tel Aviv Medical Center, Tel Aviv;,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kornelsen J, Khowaja AR, Av-Gay G, Sullivan E, Parajulee A, Dunnebacke M, Egan D, Balas M, Williamson P. The rural tax: comprehensive out-of-pocket costs associated with patient travel in British Columbia. BMC Health Serv Res 2021; 21:854. [PMID: 34419025 PMCID: PMC8380105 DOI: 10.1186/s12913-021-06833-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A significant concern for rural patients is the cost of travel outside of their community for specialist and diagnostic care. Often, these costs are transferred to patients and their families, who also experience stress associated with traveling for care. We sought to examine the rural patient experience by (1) estimating and categorizing the various out of pocket costs associated with traveling for healthcare and (2) describing and measuring patient stress and other experiences associated with traveling to seek care, specifically in relation to household income. METHODS We have designed and administered an online, retrospective, cross-sectional survey seeking to estimate the out-of-pocket (OOP) costs and personal experiences of rural patients associated with traveling to access health care in British Columbia. Respondents were surveyed across five categories: Distance Traveled and Transportation Costs, Accommodation Costs, Co-Traveler Costs, Lost Wages, and Patient Stress. Bivariate relationships between respondent household income and other numerical findings were investigated using one-way ANOVA. RESULTS On average, costs for respondents were $856 and $674 for transport and accommodation, respectively. Strong relationships were found to exist between the distance traveled and total transport costs, as well as between a patient's stress and their household income. Patient perspectives obtained from this survey expressed several related issues, including the physical and psychosocial impacts of travel as well as delayed or diminished care seeking. CONCLUSIONS These key findings highlight the existing inequities between rural and urban patient access to health care and how these inequities are exacerbated by a patient's overall travel-distance and financial status. This study can directly inform policy related efforts towards mitigating the rural-urban gap in access to health care.
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Affiliation(s)
- Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.
| | - Asif Raza Khowaja
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.,Faculty of Applied Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Gal Av-Gay
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Eva Sullivan
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Anshu Parajulee
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Marjorie Dunnebacke
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Dorothy Egan
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Mickey Balas
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Peggy Williamson
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Suite 320 - 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
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Kellish AS, Hakim A, Shahi A, Gutowski CJ, Kleiner MT. The Delivery of Orthopaedic Care midst COVID-19 and Social Distancing. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:371-378. [PMID: 34423083 PMCID: PMC8359650 DOI: 10.22038/abjs.2020.48498.2406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/07/2020] [Indexed: 11/06/2022]
Abstract
In this paper we present the findings of a literature review covering articles published in the last three decades describing the application of telemedicine in orthopaedics. A review of the PubMed Central and Medline provided 75 articles studying the role of telemedicine, the majority directly examining the application of telemedicine in orthopaedic patients. We report the summarized findings of these studies, the financial and HIPAA considerations of using telemedicine, and provide an example of our single urban level-1 trauma center's strategy for incorporating telemedicine into the clinical practice of orthopaedic surgeons during the COVID-19 pandemic.
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Affiliation(s)
- Alec S. Kellish
- Cooper Medical School of Rowan University, Camden New Jersey, USA
| | - Abraham Hakim
- Cooper Medical School of Rowan University, Camden New Jersey, USA
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Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthc J 2021; 8:e85-e91. [PMID: 33791483 DOI: 10.7861/fhj.2020-0080] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the rapidly progressing field of telemedicine, there is a multitude of evidence assessing the effectiveness and financial costs of telemedicine projects; however, there is very little assessing the environmental impact despite the increasing threat of the climate emergency. This report provides a systematic review of the evidence on the carbon footprint of telemedicine. The identified papers unanimously report that telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions. The carbon footprint savings range between 0.70-372 kg CO2e per consultation. However, these values are highly context specific. The carbon emissions produced from the use of the telemedicine systems themselves were found to be very low in comparison to emissions saved from travel reductions. This could have wide implications in reducing the carbon footprint of healthcare services globally. In order for telemedicine services to be successfully implemented, further research is necessary to determine context-specific considerations and potential rebound effects.
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Sharif F, Rahman A, Tonner E, Ahmed H, Haq I, Abbass R, Asinger S, Sbai M. Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study. Perioper Med (Lond) 2020; 9:33. [PMID: 33292556 PMCID: PMC7667783 DOI: 10.1186/s13741-020-00166-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/03/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change. METHODS Sixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes. RESULTS Various uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies. CONCLUSIONS Current literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.
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Affiliation(s)
- Faraz Sharif
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Ammar Rahman
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | | | | | - Iqraa Haq
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Rami Abbass
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Shad Asinger
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Magda Sbai
- Guy’s and St Thomas NHS Trust, London, UK
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