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Long MW, Hobson S, Dougé J, Wagaman K, Sadlon R, Price OA. Effectiveness and Cost-Benefit of an Elementary School-Based Telehealth Program. J Sch Nurs 2024; 40:248-256. [PMID: 34962171 DOI: 10.1177/10598405211069911] [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: 11/16/2022] Open
Abstract
Utilization of telehealth in school-based health centers (SBHCs) is increasing rapidly during the COVID-19 pandemic. This study used a quasi-experimental design to evaluate the effect on school absences and cost-benefit of telehealth-exclusive SBHCs at 6 elementary schools from 2015-2017. The effect of telehealth on absences was estimated compared to students without telehealth using negative binomial regression controlling for absences and health suite visits in 2014 and sociodemographic characteristics. The sample included 7,164 observations from 4,203 students. Telehealth was associated with a 7.7% (p = 0.025; 95% CI: 1.0%, 14%) reduction in absences (0.60 days/year). The program cost $189,000/yr and an estimated total benefit of $384,995 (95% CI: $60,416; $687,479) and an annual net benefit of $195,873 (95% CI: -$128,706; $498,357). While this cost-benefit analysis is limited by a lack of data on total healthcare utilization, the use of telehealth-exclusive SBHCs can improve student health and attendance while delivering cost savings to society.
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Affiliation(s)
- Michael W Long
- Center for Health and Health Care in Schools, Milken Institute School of Public Health, the George Washington University, Washington, DC, USA
| | | | | | | | - Rachel Sadlon
- Center for Health and Health Care in Schools, Milken Institute School of Public Health, the George Washington University, Washington, DC, USA
| | - Olga Acosta Price
- Center for Health and Health Care in Schools, Milken Institute School of Public Health, the George Washington University, Washington, DC, USA
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2
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Halterman JS, Fagnano M, Tremblay P, Butz A, Perry TT, Wang H. Effect of the Telemedicine Enhanced Asthma Management Through the Emergency Department (TEAM-ED) Program on Asthma Morbidity: A Randomized Controlled Trial. J Pediatr 2024; 266:113867. [PMID: 38065280 PMCID: PMC10922928 DOI: 10.1016/j.jpeds.2023.113867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To test the effectiveness of a telemedicine-based program in reducing asthma morbidity among children who present to the emergency department (ED) for asthma, by facilitating primary care follow-up and promoting delivery of guideline-based care. STUDY DESIGN We included children (3-12 years of age) with persistent asthma who presented to the ED for asthma, who were then randomly assigned to Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED) or enhanced usual care. TEAM-ED included (1) school-based telemedicine follow-ups, completed by a primary care provider, (2) point-of-care prompting to promote guideline-based care, and 3) an opportunity for 2 additional telemedicine follow-ups. The primary outcome was the mean number of symptom-free days (SFDs) over 2 weeks at 3, 6, 9, and 12 months. RESULTS We included 373 children from 2016 through 2021 (participation rate 68%; 54% Black, 32% Hispanic, 77% public insurance; mean age, 6.4 years). Demographic characteristics and asthma severity were similar between groups at baseline. Most (91%) TEAM-ED children had ≥1 telemedicine visit and 41% completed 3 visits. At 3 months, caregivers of children in TEAM-ED reported more follow-up visits (66% vs 48%; aOR, 2.07; 95% CI, 1.28-3.33), preventive asthma medication actions (90% vs 79%; aOR, 3.28; 95% CI, 1.56-6.89), and use of a preventive medication (82% vs 69%; aOR, 2.716; 95% CI, 1.45-5.08), compared with enhanced usual care. There was no difference between groups in medication adherence or asthma morbidity. When only prepandemic data were included, there was greater improvement in SFDs over time for children in TEAM-ED vs enhanced usual care. CONCLUSIONS TEAM-ED significantly improved follow-up and preventive care after an ED visit for asthma. We also saw improved SFDs with prepandemic data. The lack of overall improvement in morbidity and adherence indicates the need for additional ongoing management support. TRIAL REGISTRATION NCT02752165.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Paul Tremblay
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine and Arkansas Children's Research Institute, Little Rock, AK
| | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY
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3
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Reilly K, Walters J, Xu Y, Burkhardt MC. Seventy-Two-Hour Reutilization After Telemedicine Visits in Academic Pediatric Primary Care. Clin Pediatr (Phila) 2023; 62:1537-1542. [PMID: 36995024 DOI: 10.1177/00099228231165633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Telemedicine has expanded due to the COVID-19 pandemic. However, the health care usage after telemedicine visits compared with similar in-person visits is not known. This study compared the 72-hour health care reutilization after telemedicine visits and in-person acute encounters in a pediatric primary care office. A retrospective cohort analysis was performed in a single quaternary pediatric health care system between March 1, 2020, and November 30, 2020. Reutilization information was collected for 72 hours following the index visit and included subsequent encounters within the health care system. The 72-hour reutilization rate for telemedicine encounters was 4.1% compared with 3.9% for in-person acute visits. Of revisits, patients who had a telemedicine visit most often sought additional care at the medical home, and patients with an in-person visit most often sought additional care to the emergency department or urgent care. Telemedicine does not result in higher total health care reutilization.
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Affiliation(s)
| | - Jessica Walters
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yingying Xu
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mary Carol Burkhardt
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Mayfield CA, Priem JS, Effinger T, McGinnis S, Grinton P. School-Based Telemedicine and Reduced Avoidable Emergency Care Among Rural Pediatric Patients. Telemed J E Health 2023; 29:1819-1827. [PMID: 37172309 DOI: 10.1089/tmj.2023.0013] [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: 05/14/2023] Open
Abstract
Objective: Children living in rural communities have disparate access to preventive health care, shifting the burden of care delivery to emergency services. This study examined the association of school-based telemedicine (SBT) and avoidable emergency department (ED) utilization in rural historically underserved pediatric patients served through an SBT program. Methods: A retrospective analysis was conducted using electronic medical records and claims data from a large integrated health care system serving as the majority health care provider in the area. Participants included all pediatric patients served through an SBT program between 2017 and 2020 across three rural North Carolina counties. The study was a quasi-experimental before/after design comparing 12-month time periods before and after a patient's index virtual care visit. A subset of patients served 12 months before the start of the coronavirus 2019 (COVID-19) pandemic in 2020 was extracted and analyzed separately for a sensitivity analysis. Results: The complete sample included 1,236 patients. The odds of having an avoidable ED visit were reduced by 33% between time periods, and the estimated count of visits was reduced by 26%. (Models were adjusted for race/ethnicity, gender, age, and insurance payer.) No significant differences in unavoidable ED utilization were observed. The sensitivity analysis showed similar trends. Conclusions: Results demonstrate that telemedicine can improve access to health care and may offset the burden of avoidable care through emergency health services. Policy changes and increased use during the COVID-19 pandemic have created an optimal environment for telemedicine expansion to reduce health care access disparities.
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Affiliation(s)
- Carlene A Mayfield
- Department of Community Health, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer S Priem
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Tiffany Effinger
- Information and Analytics Services, Population Health Analytics, Atrium Health, Charlotte, North Carolina, USA
| | - Sam McGinnis
- Levine Children's Pediatric Center, Atrium Health, Charlotte, North Carolina, USA
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5
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Davis E, Fagnano M, Halterman JS, Frey SM. Utilization of the emergency department as a routine source of care among children with asthma. J Asthma 2023; 60:1377-1385. [PMID: 36399630 PMCID: PMC10192056 DOI: 10.1080/02770903.2022.2149409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Objective: To describe characteristics of children with persistent asthma in the ED who receive most of their healthcare in emergency settings; and determine whether recent asthma experiences or historic patterns of care are associated with identifying the ED as a typical location for care.Methods: We conducted a sub-analysis of baseline data from Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED), an RCT of children (3-12 years) presenting to the ED with persistent asthma (2016-2020). Caregivers identified reasons for seeking emergency care, including if their child received most overall healthcare in the ED ('ED Care'; primary outcome) or not ('Other Care'). Independent variables included demographics, recent symptoms and quality of life (QOL), and historic preventive care and healthcare use. We compared responses between ED Care and Other Care groups using bivariate and multivariate analyses.Results: We analyzed data for 355 children (31% ED Care, 69% Other Care). Compared with Other Care, ED Care respondents were more likely to identify the ED as the closest source of healthcare; report fewer symptom nights but a poorer quality of life; and describe the ED as a usual place for sick care, despite most having a PCP.Conclusions: Many children with asthma use the ED as a typical source of healthcare, and are distinguished by need for proximity, poorer caregiver QOL, and historic patterns of care-seeking. Efforts to improve timely access to outpatient care and reinforce the role of PCP-directed asthma management, such as through telemedicine, may reduce preventable morbidity including ED visits.
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Affiliation(s)
- Erin Davis
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jill S. Halterman
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sean M. Frey
- University of Rochester School of Medicine and Dentistry, Rochester, NY
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6
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Dick S, MacRae C, McFaul C, Wilson P, Turner SW. Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review. Arch Dis Child 2023; 108:486-491. [PMID: 36804396 DOI: 10.1136/archdischild-2022-324986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/08/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND There has been a rise in urgent paediatric hospital admissions and interventions to address this are required. OBJECTIVE To systemically review the literature describing community (or non-hospital)-based interventions designed to reduce emergency department (ED) visits or urgent hospital admissions. DATA SOURCES MEDLINE, Embase, OVIS SP, PsycINFO, Science Citation Index Expanded/ISI Web of Science (1981-present), the Cochrane Library database and the Database of Abstracts of Reviews of Effectiveness. STUDY ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and before-and-after studies. PARTICIPANTS Individuals aged <16 years. STUDY APPRAISAL AND SYNTHESIS METHODS Papers were independently reviewed by two researchers. Data extraction and the Critical Appraisals Skills Programme checklist was completed (for risk of bias assessment). RESULTS Seven studies were identified. Three studies were RCTs, three were a comparison between non-randomised groups and one was a before-and-after study. Interventions were reconfiguration of staff roles (two papers), telemedicine (three papers), pathways of urgent care (one paper) and point-of-care testing (one paper). Reconfiguration of staff roles resulted in reduction in ED visits in one study (with a commensurate increase in general practitioner visits) but increased hospital admissions from ED in a second. Telemedicine was associated with a reduction in children's admissions in one study and reduced ED admissions in two further studies. Interventions with pathways of care and point-of-care testing did not impact either ED visits or urgent admissions. CONCLUSIONS AND IMPLICATIONS New out-of-hospital models of urgent care for children need to be introduced and evaluated without delay. PROSPERO REGISTRATION NUMBER CRD42021274374.
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Affiliation(s)
- Smita Dick
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Clare MacRae
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire McFaul
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Philip Wilson
- Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
| | - Stephen W Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
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Uzun Kenan B, Demircioglu Kilic B, Akbalık Kara M, Taktak A, Karabay Bayazit A, Yuruk Yildirim ZN, Delibas A, Aytac MB, Conkar S, Kaya Aksoy G, Donmez O, Yel S, Saygili S, Akaci O, Buyukkaragoz B, Alpay H, Bakkaloglu SA. Evaluation of the Claria sharesource system from the perspectives of patient/caregiver, physician, and nurse in children undergoing automated peritoneal dialysis. Pediatr Nephrol 2023; 38:471-477. [PMID: 35562513 PMCID: PMC9106572 DOI: 10.1007/s00467-022-05563-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Automated peritoneal dialysis (APD) is increasingly preferred worldwide. By using a software application (Homechoice with Claria sharesource system (CSS)) with a mod-M added to the APD device, details of the home dialysis treatment become visible for PD nurses and physicians, allowing for close supervision. We aimed to evaluate the perceptions of patients/caregivers, PD nurses, and physicians about the advantages and disadvantages of CSS. METHODS Three different web-based questionnaires for patients/caregivers, nurses, and physicians were sent to 15 pediatric nephrology centers with more than 1 year of experience with CSS. RESULTS Respective questionnaires were answered by 30 patients/caregivers, 22 pediatric nephrologists, and 15 PD nurses. Most of the nurses and physicians (87% and 73%) reported that CSS improved patient monitoring. A total of 73% of nurses suggested that CCS is not well known by physicians, while half of them reported reviewing CSS data for all patients every morning. Sixty-eight percent of physicians thought that CSS helps save time for both patients/caregivers and healthcare providers by reducing visits. However, only 20% of patients/caregivers reported reduced hospital visits. A total of 90% of patients/caregivers reported that being under constant monitoring made them feel safe, and 83% stated that the patient's sleep quality improved. CONCLUSIONS A remote monitoring APD system, CSS, can be successfully applied with children for increased adherence to dialysis prescription by giving shared responsibility and may help increase the patient's quality of life. This platform is more commonly used by nurses than physicians. Its potential benefits should be evaluated in further well-designed clinical studies with larger patient groups. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Bahriye Uzun Kenan
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey
| | | | | | - Aysel Taktak
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | | | | | - Ali Delibas
- Mersin University School of Medicine, Mersin, Turkey
| | | | - Secil Conkar
- Ege University School of Medicine, Izmir, Turkey
| | | | - Osman Donmez
- Uludag University School of Medicine, Bursa, Turkey
| | - Sibel Yel
- Erciyes University School of Medicine, Kayseri, Turkey
| | - Seha Saygili
- Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Okan Akaci
- Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Bahar Buyukkaragoz
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey
| | - Harika Alpay
- Marmara University School of Medicine, Istanbul, Turkey
| | - Sevcan A Bakkaloglu
- Department of Pediatric Nephrology, Gazi University School of Medicine, Besevler, Ankara, Turkey.
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Ward MM, Merchant KA, Ullrich F, Bhagianadh D, Carter KD, Smith K, Gillette TL, Freed S, Mack LJ. Telehealth Services for Primary Care and Urgent Care to Support Rural Schools and Students. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0364] [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] Open
Affiliation(s)
- Marcia M. Ward
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA
| | | | - Fred Ullrich
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA
| | - Divya Bhagianadh
- School of Social Work, Rutgers University, New Brunswick, New Jersey, USA
| | - Knute D. Carter
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Kristin Smith
- ProMedica Coldwater Regional Hospital, Coldwater, Michigan, USA
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9
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Blackstone SR, Hauck FR. Telemedicine Use in Refugee Primary Care: Implications for Care Beyond the COVID-19 Pandemic. J Immigr Minor Health 2022; 24:1480-1488. [PMID: 35378695 PMCID: PMC8979148 DOI: 10.1007/s10903-022-01360-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
The expansion of telemedicine during the COVID-19 pandemic offers an opportunity to reach vulnerable refugee communities with limited access to healthcare; however, there are limited data on characteristics of refugee patients that are associated with telemedicine use. We examined primary care encounters between March 2020 and February 2021. We compared telemedicine encounters among refugee and non-refugee patients and examined patient characteristics associated with telemedicine use in refugee patients. Overall, refugees used telemedicine less (aOR = 0.59, p < .001). Among refugee patients, telemedicine encounters were more likely if the patient had hypertension or diabetes, had an activated patient portal, carried private insurance and spoke English as their primary language. Telemedicine may be a useful modality of care management for refugee patients who require many follow-up visits; however, language barriers remain a concern. This is important to consider as telemedicine efforts continue and are expanded.
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Affiliation(s)
- Sarah R Blackstone
- Department of Family Medicine, University of Virginia, PO Box 800729, Charlottesville, VA, 22900-0729, USA.
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia, PO Box 800729, Charlottesville, VA, 22900-0729, USA
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10
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Leventer-Roberts M, Shimoni N, Feldman B, Bachrach A, Selah T, Wolff L, Waisman Y. Diagnoses and Health Care Utilization for After-Hours Telemedicine Versus Primary Care Visits. Acad Pediatr 2021; 21:1414-1419. [PMID: 34284149 DOI: 10.1016/j.acap.2021.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The use of a nation-wide, pediatricians online (PO) after-hours telemedicine service has been offered in Israel for more than a decade. We sought to compare PO visits with those to the primary care pediatrician (PCP). METHODS This is a retrospective cross-sectional study using Israel's largest health care provider database. We included children aged 0 to 18 years using either PO or PCP between 2015 and 2018. We compared the baseline characteristics, matching by socioeconomic status, chronic illness, and diagnosis, and compared their admission rates, laboratory testing, and medication prescription. RESULTS During this study period there were 262,541 PO visits and a random 10% sample of PCP visits which yielded 1,813,103 visits. Users of PO were more likely to have a higher socioeconomic status (43% vs 28.9%), fever (13.3% vs 4.4%) and less likely to have acute respiratory conditions (8.8% vs 16.7%). Users of PO had higher rates of emergency department admissions (2.9% vs 0.4%), hospital admissions (0.9% vs 0.2%), and lower rates of laboratory testing (3.7% vs 7.4%) and medication prescription (42.0% vs 52.0%) within 24 hours. All differences were statistically significant (P < .005). CONCLUSIONS Our pediatric telemedicine service operating after-hours has been found to be feasible, and widely used, for a myriad of clinical conditions. Significant differences exist between PO and PCP visit characteristics and outcomes. However, it remained unclear whether these differences reflect the difference in the patient population or whether they are the result of the different clinical services. Further research is warranted to clarify this matter.
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Affiliation(s)
- Maya Leventer-Roberts
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai (M Leventer-Roberts), New York, NY; Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel.
| | - Nadav Shimoni
- Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel
| | - Becca Feldman
- Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel
| | - Asaf Bachrach
- Clalit Research Institute (M Leventer-Roberts, N Shimoni, B Feldman, and A Bachrach), Tel Aviv, Israel
| | - Tomer Selah
- Clalit Health Services (T Selah, L Wolff, and Y Waisman), Tel Aviv, Israel
| | - Leor Wolff
- Clalit Health Services (T Selah, L Wolff, and Y Waisman), Tel Aviv, Israel
| | - Yehezkel Waisman
- Clalit Health Services (T Selah, L Wolff, and Y Waisman), Tel Aviv, Israel
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Walters J, Johnson T, DeBlasio D, Klein M, Sikora K, Reilly K, Hutzel-Dunham E, White C, Xu Y, Burkhardt MC. Integration and Impact of Telemedicine in Underserved Pediatric Primary Care. Clin Pediatr (Phila) 2021; 60:452-458. [PMID: 34382880 DOI: 10.1177/00099228211039621] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Telemedicine, more novel in provision of pediatric care, rapidly expanded due to the recent coronavirus disease 2019 pandemic. This study aimed to determine the feasibility of telemedicine for acute and chronic care provision in an underserved pediatric primary care center. Items assessed included patient demographic data, chief complaint, and alternative care locations if telemedicine was not available. In our setting, 62% of telemedicine visits were for acute concerns and 38% for chronic concerns. Of acute telemedicine visits, 16.5% of families would have sought care in the Emergency Department/Urgent Care, and 11.3% would have opted for no care had telemedicine not been offered. The most common chronic issues addressed were attention deficit hyperactivity disorder (80.3%) and asthma (16.9%). Racial disparities existed among our telemedicine visits with Black patients utilizing telemedicine services less frequently than non-Black patients. Telemedicine is feasible for pediatric acute and chronic care, but systems must be designed to mitigate widening racial disparities.
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Affiliation(s)
- Jessica Walters
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tasha Johnson
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dominick DeBlasio
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - Melissa Klein
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - Kimberley Sikora
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristen Reilly
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Cynthia White
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yingying Xu
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mary Carol Burkhardt
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
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12
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Ferreira-Cardoso H, Jácome C, Silva S, Amorim A, Redondo MT, Fontoura-Matias J, Vicente-Ferreira M, Vieira-Marques P, Valente J, Almeida R, Fonseca JA, Azevedo I. Lung Auscultation Using the Smartphone-Feasibility Study in Real-World Clinical Practice. SENSORS (BASEL, SWITZERLAND) 2021; 21:4931. [PMID: 34300670 PMCID: PMC8309818 DOI: 10.3390/s21144931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/03/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022]
Abstract
Conventional lung auscultation is essential in the management of respiratory diseases. However, detecting adventitious sounds outside medical facilities remains challenging. We assessed the feasibility of lung auscultation using the smartphone built-in microphone in real-world clinical practice. We recruited 134 patients (median[interquartile range] 16[11-22.25]y; 54% male; 31% cystic fibrosis, 29% other respiratory diseases, 28% asthma; 12% no respiratory diseases) at the Pediatrics and Pulmonology departments of a tertiary hospital. First, clinicians performed conventional auscultation with analog stethoscopes at 4 locations (trachea, right anterior chest, right and left lung bases), and documented any adventitious sounds. Then, smartphone auscultation was recorded twice in the same four locations. The recordings (n = 1060) were classified by two annotators. Seventy-three percent of recordings had quality (obtained in 92% of the participants), with the quality proportion being higher at the trachea (82%) and in the children's group (75%). Adventitious sounds were present in only 35% of the participants and 14% of the recordings, which may have contributed to the fair agreement between conventional and smartphone auscultation (85%; k = 0.35(95% CI 0.26-0.44)). Our results show that smartphone auscultation was feasible, but further investigation is required to improve its agreement with conventional auscultation.
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Affiliation(s)
| | - Cristina Jácome
- MEDCIDS—Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (R.A.); (J.A.F.)
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;
| | - Sónia Silva
- Department of Pediatrics, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (S.S.); (J.F.-M.); (M.V.-F.); (I.A.)
| | - Adelina Amorim
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (H.F.-C.); (A.A.)
- Department of Pulmonology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
| | - Margarida T. Redondo
- Department of Pulmonology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
| | - José Fontoura-Matias
- Department of Pediatrics, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (S.S.); (J.F.-M.); (M.V.-F.); (I.A.)
| | - Margarida Vicente-Ferreira
- Department of Pediatrics, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (S.S.); (J.F.-M.); (M.V.-F.); (I.A.)
| | - Pedro Vieira-Marques
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;
| | - José Valente
- MEDIDA—Serviços em Medicina, Educação, Investigação, Desenvolvimento e Avaliação, LDA, 4200-386 Porto, Portugal;
| | - Rute Almeida
- MEDCIDS—Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (R.A.); (J.A.F.)
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;
| | - João Almeida Fonseca
- MEDCIDS—Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (R.A.); (J.A.F.)
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;
- MEDIDA—Serviços em Medicina, Educação, Investigação, Desenvolvimento e Avaliação, LDA, 4200-386 Porto, Portugal;
| | - Inês Azevedo
- Department of Pediatrics, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; (S.S.); (J.F.-M.); (M.V.-F.); (I.A.)
- Department of Obstetrics, Gynecology and Pediatrics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- EpiUnit, Institute of Public Health, University of Porto, 4050-091 Porto, Portugal
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A Telehealth Initiative to Decrease No-Show Rates in a Pediatric Asthma Mobile Clinic. J Pediatr Nurs 2021; 59:143-150. [PMID: 33887684 DOI: 10.1016/j.pedn.2021.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PROBLEM Failed patient care appointments (no-shows) can lead to negative patient health outcomes and increased healthcare costs. There is evidence that telehealth is a safe, effective, and a cost-efficient option for those unable to attend in-person visits. No-show rates in pediatrics are unique due to reliance on caregivers to attend appointments. A pediatric asthma mobile van, which provides specialty care to children at schools in low-income communities in Chicago, was experiencing a high no-show rate. METHODS/INTERVENTIONS Building on evidence that the use of telehealth technology improves access to care, the purpose of this quality improvement initiative was to implement a new telehealth option for off-site parents to attend their child's on-site appointment. The designed initiative followed the Plan-Do-Study-Act model with three small phases of change. The first phase assessed telehealth interest using a Likert-scale questionnaire. The second phase designed and implemented a telehealth option and collected no-show rates pre- and post- implementation. The final phase assessed parental satisfaction using a Telehealth Usability Questionnaire. RESULTS Over 50% of participants stated interest in the parent off-site telehealth option for their child's appointment. No-show rates decreased from 36% to 7.9%-18% per month over a 10-month implementation period. Post-telehealth surveys completed by parents revealed this version of telehealth improved access to care for their child, saved them time, and was simple to use. CONCLUSION No-show rates decreased after successful implementation of an innovative approach to telehealth. This parent off-site telehealth model can be another approach toward increasing pediatric healthcare access.
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Ravi N, Gitz KM, Burton DR, Ray KN. Pediatric non-urgent emergency department visits and prior care-seeking at primary care. BMC Health Serv Res 2021; 21:466. [PMID: 34001093 PMCID: PMC8128083 DOI: 10.1186/s12913-021-06480-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to examine how caregiver perceptions of primary care affects care-seeking prior to pediatric non-urgent ED visits. METHODS We performed a cross-sectional survey of caregivers of children presenting to a pediatric ED during weekday business hours and triaged as low acuity. We first compared caregiver sociodemographic characteristics, perceptions of primary care, and stated preference in care sites (ED vs PCP) for caregivers who had sought care from their child's PCP office versus had not sought care from their child's PCP office prior to their ED visit. We then examined odds of having sought care from their PCP office prior to their ED visit using multivariable logistic regression models sequentially including caregiver primary care perceptions and stated care site preferences along with caregiver sociodemographic characteristics. RESULTS Of 140 respondents, 64 (46%) sought care from their child's PCP office prior to presenting to the ED. In unadjusted analysis, children insured by Medicaid or CHIP, caregivers identifying as Black, and caregivers with lower educational attainment were less likely to have sought PCP care before presenting to the ED (p < 0.005, each). Caregivers who had sought PCP care were more likely to prefer their PCP relative to the ED in terms of ease of travel, cost, and wait times (p < 0.001, all). When including these stated preferences in a multivariable model, child insurance, caregiver race, and caregiver education were no longer significantly associated with odds of having sought PCP care prior to their ED visit. CONCLUSIONS Differential access to primary care may underlie observed demographic differences in non-urgent pediatric ED utilization.
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Affiliation(s)
- Nithin Ravi
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue,AOB - Suite 5400, Pittsburgh, PA, 15224, USA.
| | - Katherine M Gitz
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue,AOB - Suite 5400, Pittsburgh, PA, 15224, USA
- Children's Hospital of Los Angeles Medical Group, Los Angeles, USA
| | - Danielle R Burton
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kristin N Ray
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue,AOB - Suite 5400, Pittsburgh, PA, 15224, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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15
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Perry TT, Turner JH. School-Based Telemedicine for Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2524-2532. [PMID: 31706484 DOI: 10.1016/j.jaip.2019.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 10/25/2022]
Abstract
Asthma affects 10% of school-age children in the United States. These numbers nearly double in high-risk populations such as low-income and minority populations. Patients in these populations frequently live in communities that are medically underserved, with limited resources to implement comprehensive asthma interventions. It is important for researchers and clinicians to explore avenues to reduce the burden of illness in this population. Incorporating innovative strategies such as school-based telemedicine programs can potentially reduce morbidity, health care utilization, work absenteeism for caregivers, and school absenteeism for children with asthma. The aim of this review is to discuss the potential benefits of school-based asthma telemedicine programs, explore potential implementation models, and provide a comprehensive review of the literature including programs that use telemedicine in schools to assist with the management of asthma. Telemedicine is a feasible approach to increasing access to primary and specialty asthma care; however, there is a need for future randomized trials to establish best practices for implementation of telemedicine programs to aid in the care for children in school settings.
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Affiliation(s)
- Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark.
| | - Jessica H Turner
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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16
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Stamenova V, Agarwal P, Kelley L, Fujioka J, Nguyen M, Phung M, Wong I, Onabajo N, Bhatia RS, Bhattacharyya O. Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada. BMJ Open 2020; 10:e037064. [PMID: 32636284 PMCID: PMC7342856 DOI: 10.1136/bmjopen-2020-037064] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care. DESIGN A retrospective cohort study. SETTING Primary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services. PARTICIPANTS 326 primary care providers and 14 291 registered patients. INTERVENTIONS Providers used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication. MAIN OUTCOME MEASURES User-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients' satisfaction. RESULTS Among the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again. CONCLUSIONS While there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.
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Affiliation(s)
- Vess Stamenova
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Payal Agarwal
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leah Kelley
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Jamie Fujioka
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Megan Nguyen
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Phung
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Ivy Wong
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Nike Onabajo
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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17
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Foster CC, Macy ML, Simon NJ, Stephen R, Lehnig K, Bohling K, Schinasi DA. Emergency Care Connect: Extending Pediatric Emergency Care Expertise to General Emergency Departments Through Telemedicine. Acad Pediatr 2020; 20:577-584. [PMID: 32112864 DOI: 10.1016/j.acap.2020.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 01/08/2023]
Abstract
Increasingly, children with common and lower-acuity conditions are being transferred from general emergency departments (EDs) to pediatric centers for subspecialty care. While transferring children with high-risk conditions has benefit, transferring children with common conditions may expose them to redundant care and added costs. Emergency Care Connect (ECC) is a novel telemedicine program that uses videoconferencing to connect general ED and urgent care providers to pediatric emergency medicine physicians with the goal of keeping children in their communities for definitive care, when safe and feasible. ECC objectives are to: 1) facilitate transfer decision-making for children receiving care in general ED and urgent care sites and 2) increase access to pediatric providers for real-time management, regardless of disposition. In its first 20 months, ECC partnered with 4 general EDs and 1 urgent care location, which together made 1327 contacts with our pediatric center, of which 202 (15%) became ECC consultations for 200 unique patients. Of those consultations, 71% patients remained locally for treatment and 25% experienced a care plan change. Overall, ECC was rated highly by surveyed families and providers. Barriers to implementation, such as lack of familiarity with telemedicine and fears of changes in workflow, were overcome with strong institutional support and frequent, sustained stakeholder engagement. With greater adoption of this model, ECC and programs like it have the potential to allow more children to be treated in their communities, minimize preventable transfers, and reserve beds in children's hospitals for those with potentially higher risk and more medically complex conditions.
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Affiliation(s)
- Carolyn C Foster
- Department of Pediatrics, Northwestern Feinberg School of Medicine (CC Foster, ML Macy, R Stephen, and DA Schinasi), Chicago, Ill; Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago (CC Foster), Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (CC Foster and ML Macy), Chicago, Ill; Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago (CC Foster, ML Macy, R Stephen, K Bohling, and DA Schinasi), Chicago, Ill.
| | - Michelle L Macy
- Department of Pediatrics, Northwestern Feinberg School of Medicine (CC Foster, ML Macy, R Stephen, and DA Schinasi), Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (CC Foster and ML Macy), Chicago, Ill; Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago (CC Foster, ML Macy, R Stephen, K Bohling, and DA Schinasi), Chicago, Ill; Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago (ML Macy, N-J Simon, K Lehnig, and DA Schinasi), Chicago, Ill
| | - Norma-Jean Simon
- Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago (ML Macy, N-J Simon, K Lehnig, and DA Schinasi), Chicago, Ill
| | - Rebecca Stephen
- Department of Pediatrics, Northwestern Feinberg School of Medicine (CC Foster, ML Macy, R Stephen, and DA Schinasi), Chicago, Ill; Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago (CC Foster, ML Macy, R Stephen, K Bohling, and DA Schinasi), Chicago, Ill; Hospital-Based Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago (R Stephen), Chicago, Ill
| | - Katherine Lehnig
- Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago (ML Macy, N-J Simon, K Lehnig, and DA Schinasi), Chicago, Ill
| | - Katie Bohling
- Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago (CC Foster, ML Macy, R Stephen, K Bohling, and DA Schinasi), Chicago, Ill
| | - Dana A Schinasi
- Department of Pediatrics, Northwestern Feinberg School of Medicine (CC Foster, ML Macy, R Stephen, and DA Schinasi), Chicago, Ill; Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago (CC Foster, ML Macy, R Stephen, K Bohling, and DA Schinasi), Chicago, Ill; Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago (ML Macy, N-J Simon, K Lehnig, and DA Schinasi), Chicago, Ill
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Abstract
OBJECTIVES Pediatric patients living in rural, underserved areas have reduced access to medical care. There is a lack of research describing the use of telemedicine (TM) for general pediatric emergency medicine (PEM). In 2013, we established the Child Ready Virtual Pediatric Emergency Department Telehealth Network (CR-VPED), a PEM TM consultation service serving rural hospitals across the state of New Mexico. The aim of this article is to describe our experience for 6 years (2013-2018). METHODS We describe the process of establishing the CR-VPED Telehealth Network. We reviewed all the TM consultations completed from June 22, 2013, to September 6, 2018. In our review, we focus on patient demographics, medical complaint, transfer status, type of referring provider, and problems encountered with each TM consultation. RESULTS We had a total of 58 PEM TM consultations between June 22, 2013, and September 6, 2018. All consultations occurred at 6 of the 12 established sites. Most TM consultations (71%; 41/58) were with Indian Health Service sites. Among all TM consultations, patients ranged in age from 30 days to 17 years (mean, 54 months; median, 32 months). Only 26% (15/58) of the patients with TM consultations were transferred to the tertiary care hospital. There was a heterogeneous mix of chief complaints and diagnoses. Rash was the most common chief complaint (24%; 14/58). There was a mix of referring providers, with family medicine physicians being most common (31%; 18/58). Common technical issues were not properly recording the encounter into the electronic medical record (12%; 7/58) and difficulty logging into the CR-VPED Telehealth Network (9%; 5/58). CONCLUSIONS Previous studies have investigated the use of TM in pediatric acute care, but most studies have focused on critical care or subspecialty care in the office setting. Our experience with CR-VPED has shown that it has been feasible to provide general pediatric emergency care to patients in underserved, rural emergency departments across New Mexico. Patients requiring TM consultation were heterogeneous in age and presentation.
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Abstract
OBJECTIVES Our goal was to describe the experiences after the launch of a pediatric emergency telemedicine program at a large, urban, academic medical center. METHODS We launched 3 unique pediatric emergency telemedicine programs at an urban, academic medical center: direct-to-consumer pediatric virtual urgent care, pediatric emergency department (PED) telemedicine follow-up, and telemedicine medical screening examination in the PED. RESULTS We evaluated 84 patients via direct-to-consumer pediatric virtual urgent care with the most common chief complaint related to fever, dermatologic, or respiratory systems; we referred 12% to the PED, and 20% of those required hospital admission. We evaluated 38 patients via PED telemedicine follow-up; we referred 19% back to the PED, and 43% of those required hospital admission. Median duration for a telemedicine encounter was 10 minutes. We screened 3809 patients in the PED using telemedicine medical screening examination. CONCLUSIONS We offer a description of an innovative and comprehensive new pediatric emergency telemedicine program implemented at a large, urban, academic medical center. Our initial findings demonstrate short visit times, antibiotic stewardship, and low rates of PED referral and subsequent admission for patients who use a telemedicine service. We plan to further examine the impact of pediatric emergency telemedicine on the care of children as our program expands.
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20
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Frey SM, Milne Wenderlich A, Halterman JS. New Opportunities With School-Based Telehealth: Convenient Connections to Care. JAMA Pediatr 2019; 173:1017-1018. [PMID: 31498381 DOI: 10.1001/jamapediatrics.2019.3083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sean M Frey
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Andrea Milne Wenderlich
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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21
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Dayal P, Chang CH, Benko WS, Pollock BH, Crossen SS, Kissee J, Ulmer AM, Hoch JS, Warner L, Marcin JP. Hospital Utilization Among Rural Children Served by Pediatric Neurology Telemedicine Clinics. JAMA Netw Open 2019; 2:e199364. [PMID: 31418803 PMCID: PMC6704740 DOI: 10.1001/jamanetworkopen.2019.9364] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/26/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Telemedicine is increasingly used to provide outpatient pediatric neurology consultations in underserved communities. Although telemedicine clinics have been shown to improve access, little is known about how they alter patients' utilization of hospital services. Objective To evaluate the association between access to telemedicine clinics and hospital utilization among underserved children with neurologic conditions. Design, Setting, and Participants This retrospective cross-sectional study included 4169 patients who received outpatient care from pediatric neurologists affiliated with an academic children's hospital in California between January 1, 2009, and July 31, 2017, either in person or using telemedicine. Exposures Consultation modality (telemedicine or in person) in the outpatient neurology clinics. Main Outcomes and Measures Demographic and clinical variables were abstracted from the hospital's electronic medical records. The association between the modality of outpatient neurology care and patients' utilization of the emergency department and hospitalizations was evaluated. Both all-cause and neurologic condition-related hospital utilization were analyzed using multivariable negative binomial regression in overall and matched samples. Results The telemedicine cohort comprised 378 patients (211 [55.8%] male), and the in-person cohort comprised 3791 patients (2090 [55.1%] male). The mean (SD) age at the first encounter was 7.4 (5.4) years for the telemedicine cohort and 7.8 (5.1) years for the in-person cohort. The telemedicine cohort was more likely than the in-person cohort to have nonprivate insurance (public insurance, self-pay, or uninsured), lower education, and lower household income. The rates of all-cause and neurologic hospital encounters were lower among children who received pediatric neurology consultations over telemedicine compared with children who received care in the in-person clinics (5.7 [95% CI, 3.5-8.0] vs 20.1 [95% CI, 18.1-22.1] per 100 patient-years and 3.7 [95% CI, 2.0-5.3] vs 8.9 [95% CI, 7.8-10.0] per 100 patient-years, respectively; P < .001). Even after adjusting for demographic and clinical factors, the telemedicine cohort had a lower risk of hospital encounters (emergency department visits and admissions) with an adjusted incidence rate ratio of 0.57 (95% CI, 0.38-0.88) for all-cause encounters and an adjusted incidence rate ratio of 0.60 (95% CI, 0.36-0.99) for neurologic encounters. After matching on travel time to the neurology clinic, the adjusted incidence rate ratio was 0.19 (95% CI, 0.04-0.83) for all-cause admissions and 0.14 (95% CI, 0.02-0.82) for neurologic admissions. Conclusions and Relevance Pediatric neurology care through real-time, audiovisual telemedicine consultations was associated with lower hospital utilization compared with in-person consultations, suggesting that high-cost hospital encounters can be prevented by improving subspecialty access.
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Affiliation(s)
- Parul Dayal
- Department of Pediatrics, University of California Davis Health, Sacramento
- Now with Genentech Inc, South San Francisco, California
| | - Celia H. Chang
- Department of Neurology, University of California Davis Health, Sacramento
| | - William S. Benko
- Department of Neurology, University of California Davis Health, Sacramento
| | - Brad H. Pollock
- Department of Public Health Sciences, University of California Davis Health, Sacramento
| | | | - Jamie Kissee
- Department of Pediatrics, University of California Davis Health, Sacramento
| | - Aaron M. Ulmer
- Center for Health and Technology, University of California Davis Health, Sacramento
| | - Jeffrey S. Hoch
- Department of Public Health Sciences, University of California Davis Health, Sacramento
- Center for Healthcare Policy and Research, University of California Davis Health, Sacramento
| | | | - James P. Marcin
- Department of Pediatrics, University of California Davis Health, Sacramento
- Center for Health and Technology, University of California Davis Health, Sacramento
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22
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Ray KN, Shi Z, Poon SJ, Uscher-Pines L, Mehrotra A. Use of Commercial Direct-to-Consumer Telemedicine by Children. Acad Pediatr 2019; 19:665-669. [PMID: 30639759 PMCID: PMC6620157 DOI: 10.1016/j.acap.2018.11.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/23/2018] [Accepted: 11/03/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In commercial direct-to-consumer (DTC) telemedicine, physicians outside of the medical home treat common, acute complaints through real-time, audio-visual conferencing using telephones and personal computers. There has been little examination of the use of DTC telemedicine by children. We describe trends in DTC telemedicine use and DTC telemedicine visit characteristics. METHODS Using 2011-2016 claims from a large national health plan, we identified pediatric acute visits to DTC telemedicine and to primary care providers (PCPs). We examined DTC telemedicine visit trends and compared DTC telemedicine and acute PCP visit diagnoses and patient characteristics. RESULTS From 2011 through 2016, pediatric DTC telemedicine visits increased from 38 to 24,409 visits annually. In 2015 and 2016, the most common primary diagnoses for DTC telemedicine visits (n = 42,072) were infections of the nose/sinuses (24%), mouth/throat (16%), and ear (9%), which were also the most common diagnoses for acute PCP visits (n = 6,917,976). Odds of DTC telemedicine use were higher for children in non-metropolitan communities (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.40-1.51) and children without preventive visits (OR, 1.08; 95% CI, 1.06-1.11). Compared to children receiving acute PCP care, children with DTC telemedicine visits were also more likely to have had urgent care (17% vs 10%; P < .001) and emergency department visits (21% vs 19%; P < .001) during the study period. CONCLUSIONS The use of commercial DTC telemedicine visits for children is growing rapidly, primarily for acute respiratory infections. Compared to children who did not use DTC telemedicine for acute care, children using DTC telemedicine were also more likely to use other venues for acute care outside of the medical home.
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Affiliation(s)
- Kristin N Ray
- Department of Pediatrics (KN Ray), University of Pittsburgh School of Medicine, Pittsburgh, Penn.
| | - Zhuo Shi
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Sabrina J Poon
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA,RAND Corporation, Boston, MA
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23
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Sax DR, Vinson DR, Yamin CK, Huang J, Falck TM, Bhargava R, Amaral DJ, Reed ME. Tele-Triage Outcomes For Patients With Chest Pain: Comparing Physicians And Registered Nurses. Health Aff (Millwood) 2019; 37:1997-2004. [PMID: 30633669 DOI: 10.1377/hlthaff.2018.05079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We took advantage of a change in protocol in an integrated delivery system's telephone consultation service-routing callers complaining of chest pain to physicians instead of registered nurses, whenever feasible-to explore whether tele-triage outcomes differed by staffing type. Comparing outcomes of 11,315 physician-directed calls to those of an equal number of nurse-directed calls in 2013, we found that the physician-directed calls were briefer (eight minutes versus thirteen minutes), produced fewer ED referrals (10 percent versus 16 percent), and resulted in higher patient adherence to the providers' site-of-care recommendation (86 percent versus 82 percent). Mortality rates at seven days were low for both physician- and nurse-directed calls (0.1 percent). We suspect that providers' immediate access to callers' comprehensive electronic health records and patients' rapid access to outpatient care likely contributed to the program's success. Our findings suggest that tele-triage can be used to safely and effectively manage an emergent complaint, and that physicians' expertise may bring additional efficiency to the process.
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Affiliation(s)
- Dana R Sax
- Dana R. Sax ( ) is an emergency physician at Kaiser Permanente Oakland Medical Center, in California
| | - David R Vinson
- David R. Vinson is an emergency physician at Kaiser Permanente Sacramento Medical Center, in California
| | - Cyrus K Yamin
- Cyrus K. Yamin is an emergency physician at Kaiser Permanente Oakland Medical Center
| | - Jie Huang
- Jie Huang is a programmer/analyst in the Division of Research, Kaiser Permanente, in Oakland
| | - Troy M Falck
- Troy M. Falck is regional assistant clinical director at the Appointment and Advice Call Center, Permanente Medical Group, in Oakland
| | - Reena Bhargava
- Reena Bhargava is an internist in the Department of Internal Medicine, Kaiser Permanente Santa Clara Medical Center, in California
| | - Debra J Amaral
- Debra J. Amaral is a leader of strategic innovationat the Appointment and Advice Call Center, Permanente Medical Group
| | - Mary E Reed
- Mary E. Reed is a research scientist in the Division of Research, Kaiser Permanente
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Hertzog R, Johnson J, Smith J, McStay FW, da Graca B, Haneke T, Heavener T, Couchman GR. Diagnostic Accuracy in Primary Care E-Visits: Evaluation of a Large Integrated Health Care Delivery System's Experience. Mayo Clin Proc 2019; 94:976-984. [PMID: 31171135 DOI: 10.1016/j.mayocp.2019.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare diagnostic accuracy between primary care E-Visit and face-to-face (F2F) encounters for low-acuity illnesses. PATIENTS AND METHODS This cross-sectional retrospective analysis of electronic health records in a large not-for-profit integrated delivery system included patients covered by the health care system's employee health plan with an established affiliated physician-patient relationship and an F2F encounter in the past 12 months who had an E-Visit (n=490) or an F2F (n=2201) primary care encounter for a low-acuity illness from July 1, 2015, through December 22, 2016. Patients with a related follow-up visit within 10 days resulting in a revised diagnosis, as determined by 2 physician reviewers, were compared (1) including only the first encounter for each patient and (2) including all encounters more than 10 days apart for included patients. RESULTS In both analyses, a follow-up visit occurred within 10 days more than 40% of the time in both groups. However, follow-up visits related to the initial diagnosis occurred only 9% to 12% of the time. Only 2.1% to 2.4% of initial diagnoses were identified by both physician reviewers as revised, whereas 3.8% to 5.5% were so identified by at least 1 reviewer. The only significant difference observed between the E-Visit and F2F groups was in the rate of related follow-up visits when only each patient's first encounter was considered, which was higher for E-Visits (12% vs 9%; P=.04). CONCLUSION Diagnostic accuracy for low-acuity illnesses in this population was equivalent between E-Visit and F2F encounters.
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Affiliation(s)
- Rhonda Hertzog
- Office of the Chief Medical Officer, Central Texas, Baylor Scott & White Health, Dallas, TX
| | - Justin Johnson
- Office of the Chief Medical Officer, Central Texas, Baylor Scott & White Health, Dallas, TX
| | - James Smith
- Office of the Chief Medical Officer, Central Texas, Baylor Scott & White Health, Dallas, TX
| | - Frank W McStay
- Center for Healthcare Policy, Baylor Scott & White Health, Temple, TX.
| | - Briget da Graca
- Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX; Robbins Institute for Health Policy and Leadership, Baylor University, Waco, TX
| | - Travis Haneke
- Department of Medicine, Baylor Scott & White Medical Center-Temple, TX
| | - Trace Heavener
- Department of Medicine, Baylor Scott & White Medical Center-Temple, TX
| | - Glen R Couchman
- Office of the Chief Medical Officer, Central Texas, Baylor Scott & White Health, Dallas, TX
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Notario PM, Gentile E, Amidon M, Angst D, Lefaiver C, Webster K. Home-Based Telemedicine for Children with Medical Complexity. Telemed J E Health 2019; 25:1123-1132. [PMID: 30628860 PMCID: PMC6842894 DOI: 10.1089/tmj.2018.0186] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Children with medical complexity (CMC) are high utilizers of health care services. Telehealth encounters may provide a means to improve care outcomes for this population. Objective: To evaluate the feasibility, usability, and impact of an in-home telehealth device in the care of CMC. Methods: This single-center feasibility study employed a nonblinded randomized clinical trial design. English-speaking caregivers of children within a pediatric complex care program with home Wi-Fi were eligible for participation. Participants were randomized 1.5:1 with stratification based on tracheostomy status to a control group that received usual care or an intervention group that received a telehealth device for in-home use. Patients were followed up for 4 months. The primary outcome was successful device connectivity and data transmission. Data included clinician encounter device usability; caregiver satisfaction; and encounter type, purpose, and cost. Descriptive statistics, negative binomial regression, and Kaplan–Meier plot were used for analysis. Results: Twenty-four patients were enrolled (9 controls, 15 in the intervention group) in September 2016. The telehealth device was attempted in 73 encounters. Device connectivity was successful 96% of the time. Image and sound quality were acceptable in 98% of visits. Caregivers expressed their overall satisfaction with the device. The hospitalization rate was lower in the intervention group (0.77 vs. 1.14 intensive care unit days/patient-months), resulting in $9,425/USD per patient savings compared with the control group. Conclusion: Despite small sample size and short observation period, this study demonstrated that use of an in-home telehealth device is feasible, well received by caregivers, and can result in decreased hospitalizations when compared with usual care.
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McConnochie KM. Webside Manner: A Key to High-Quality Primary Care Telemedicine for All. Telemed J E Health 2019; 25:1007-1011. [PMID: 30648924 DOI: 10.1089/tmj.2018.0274] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Evaluation of telemedicine, including videoconferencing, specifically focused on primary care, has demonstrated quality as good as in-person care, reduced cost, elimination of socioeconomic disparities in access, and high levels of patient satisfaction. Distinctly different care models are currently marketed by provider organizations as telemedicine. Inclusion (or not) of videoconferencing capacity constitutes a distinguishing feature that is likely to impact effectiveness, but provider organizations, regulatory agencies, and payers have largely overlooked this distinction. Reassurance reducing patient and family anxiety has long been recognized as essential to both patient satisfaction and value of the medical profession. Interaction that reduces anxiety requires empathic communication. Interpersonal communication involves more than words; also key are intonation of voice, facial expression, body language, and capacity to accurately "read" emotions in others and to respond effectively. Telemedicine with videoconferencing has been shown to redress disparities in access while providing high-quality care that is well accepted by both patients and providers. Technical and practical barriers to inclusion of videoconferencing in telemedicine are minimal. Real-time video interaction, enabling "webside manner," should be the default communication mode as telemedicine is increasingly accepted by patients, clinicians, and provider organizations as a tool to ensure high-quality primary care for all.
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Affiliation(s)
- Kenneth M McConnochie
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
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Sanchez D, Reiner JF, Sadlon R, Price OA, Long MW. Systematic Review of School Telehealth Evaluations. J Sch Nurs 2018; 35:61-76. [PMID: 30798692 DOI: 10.1177/1059840518817870] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
School telehealth is an alternative delivery model to increase student health-care access with minimal evaluation to aid decision makers in the adoption or expansion of programs. This systematic review assesses school-based telehealth programs using a dissemination and implementation (D&I) framework to inform practitioners and decision makers of the value of school telehealth. We assessed findings from 20 studies on telehealth published between January 2006 and June 2018 and summarized program evaluation on a range of D&I constructs. The sample population included children in school- or center-based early childhood education under age 22 and included parents, providers, and school personnel across urban and suburban locations. There is some evidence that school telehealth can reduce emergency department visits and improve health status for children with chronic and acute illnesses. Future research should report on barriers and facilitators of implementation of programs, including costs related to application of telehealth services and utilization rates.
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Affiliation(s)
- Denisse Sanchez
- 1 Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Jennifer F Reiner
- 1 Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Rachel Sadlon
- 2 Department of Prevention and Community Health, Center for Health and Health Care in Schools, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Olga Acosta Price
- 2 Department of Prevention and Community Health, Center for Health and Health Care in Schools, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Michael W Long
- 1 Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Louie MC, Chang TP, Grundmeier RW. Recent Advances in Technology and Its Applications to Pediatric Emergency Care. Pediatr Clin North Am 2018; 65:1229-1246. [PMID: 30446059 DOI: 10.1016/j.pcl.2018.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Advances in technology are continuously transforming medical care, including pediatric emergency medicine. The increasing adoption of point-of-care ultrasound examination can improve timely diagnoses without radiation and aids the performance of common procedures. The recent dramatic increase in electronic health record adoption offers an opportunity for enhanced clinical decision-making support. Simulation training and advances in technologies can provide continued proficiency training despite decreasing opportunities for pediatric procedures and cardiorespiratory resuscitation performance. This article reviews these and other recent advances in technology that have had the greatest impact on the current practice of pediatric emergency medicine.
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Affiliation(s)
- Marisa C Louie
- Department of Emergency Medicine, University of Michigan Medical School, Mott Children's Hospital, 1540 East Hospital Drive, CW 2-737, Ann Arbor, MI 48109, USA; Department of Pediatrics, University of Michigan Medical School, Mott Children's Hospital, 1540 East Hospital Drive, CW 2-737, Ann Arbor, MI 48109, USA.
| | - Todd P Chang
- Pediatric Emergency Medicine, Keck School of Medicine at University of Southern California, Children's Hospital Los Angeles, 4650 Sunset Boulevard Mailstop 113, Los Angeles, CA 90027, USA
| | - Robert W Grundmeier
- Department of Biomedical and Health Informatics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Roberts Center, 2716 South Street, 15th Floor, Philadelphia, PA 19146, USA
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Halterman JS, Tajon R, Tremblay P, Fagnano M, Butz A, Perry T, McConnochie K. Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr Robert Haggerty. Acad Pediatr 2017; 17:595-599. [PMID: 28434913 PMCID: PMC5599804 DOI: 10.1016/j.acap.2017.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/08/2017] [Indexed: 12/28/2022]
Abstract
In the spirit of Dr. Haggerty's teachings, we present an overview of our work to improve care for children with asthma in the context of 3 lessons learned: 1) the importance of providing integrated services across disciplinary boundaries for children with chronic illness, 2) the need to move from a care model focused only on the individual child to a model focused on the child, family, and community, and 3) the need to expand beyond the local community and take a broad perspective on improving health on a national level. The goal of our program is to develop sustainable models to overcome the multiple obstacles to effective preventive care for urban children with asthma. The primary intervention for our original School-Based Asthma Therapy program was directly observed administration of preventive asthma medications in school (with dose adjustments on the basis of National Heart, Lung, and Blood Institute guidelines). We found that children who received preventive medications in school through directly observed therapy had improved outcomes across multiple outcome measures. Our subsequent asthma programs have focused on dissemination and sustainability, with the incorporation of communication technology to enhance the system of care. We are currently testing the 'School-Based Telemedicine Enhanced Asthma Management' program, including 400 children with persistent asthma from the Rochester City School District. This program includes directly observed administration of preventive asthma medication at school, and school-based telemedicine to assure appropriate evaluation, preventive medication prescription, and follow-up care. It is designed to implement and sustain guideline-based asthma care through existing community infrastructure, and could serve as a model for the integration of services in rural as well as urban communities.
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Affiliation(s)
| | - Reynaldo Tajon
- Pediatrics, University of Rochester, Rochester, New York, United States
| | - Paul Tremblay
- Pediatrics, University of Rochester, Rochester, New York, United States
| | - Maria Fagnano
- Pediatrics, University of Rochester, Rochester, New York, United States
| | - Arlene Butz
- Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland, United States
| | - Tamara Perry
- Pediatrics, University of Arkansas, Little Rock, AR, United States
| | - Ken McConnochie
- Pediatrics, University of Rochester, Rochester, New York, United States
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Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation. Pediatr Emerg Care 2017; 33:474-479. [PMID: 26945195 DOI: 10.1097/pec.0000000000000653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children transferred from community hospitals lacking specialized pediatric care are more seriously ill than those presenting to pediatric centers. Pediatric consultation and adherence to management guidelines improve outcomes. The aims of the study were (1) to assess whether telemedicine consultation in critical situations is feasible and (2) to compare the impact of pediatric critical care medicine (PCCM) consultation via telemedicine versus telephone on community hospital adherence to resuscitation guidelines through a randomized controlled telemedicine trial. METHODS In situ, high-fidelity simulation scenarios of critically ill children presenting to a community hospital and progressing to cardiopulmonary arrest were performed. Scenarios were randomized to PCCM consultation via telephone (control) or telemedicine (intervention). Primary outcome measure was proportion of teams who successfully defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia. RESULTS The following 30 scenarios were completed: 15 control and 15 intervention. Only 11 (37%) of 30 teams, defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia; control: 6 (40%) of 15 versus intervention: 5 (33%) of 15, P = 0.7. Request for or use of backboard during cardiopulmonary resuscitation occurred in 24 (80%) of 30 scenarios; control: 9 (60%) of 15 versus intervention: 15 (100%) of 15, P = 0.006. Request for or use of stepstool during cardiopulmonary resuscitation occurred in 6 (20%) of 30 scenarios; control: 1 (7%) of 15 versus intervention: 5 (33%) of 15, P = 0.07. CONCLUSIONS This study demonstrates the feasibility of using telemedicine to support acute management of children who present to community hospitals. Neither study arm adhered to current resuscitation guidelines and telemedicine consultation with PCCM experts was not associated with improvement. However, further research on optimizing telemedicine impact on the quality of pediatric care at community hospitals is warranted.
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The American Telemedicine Association ATA 2017 Telehealth 2.0 Conference Abstracts. Telemed J E Health 2017; 23:A1-A78. [PMID: 28410061 DOI: 10.1089/tmj.2017.29005-a.abstracts] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Urgent Care as Intermediary Care: How Inbound and Outbound Transport Can Enhance Care of Community-Based Pediatric Emergencies. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ronis SD, McConnochie KM, Wang H, Wood NE. Urban Telemedicine Enables Equity in Access to Acute Illness Care. Telemed J E Health 2017; 23:105-112. [DOI: 10.1089/tmj.2016.0098] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah D. Ronis
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Nancy E. Wood
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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Abstract
INTRODUCTION Potential for direct patient care through remote exchange of health-related information has expanded enormously with the proliferation of technologies leveraging ubiquitous connectivity, but implementation of connected care has been slow and controversial. MATERIALS AND METHODS This review demonstrates that controversy regarding connected care arises largely from the fact that proponents and critics are generally considering distinctly different care models. Differences are highlighted to mitigate controversy and to distinguish capacities of these different models. RESULTS Distinguishing capacities is essential for establishing the evidence base supporting safety, effectiveness, and efficiency. In care of a particular patient's problem, value is achieved when resources allocated meet requirements for diagnosis and intervention but do not exceed them. Robust evidence supports the value of some well-defined connected care models, exemplified by the Health-e-Access Telemedicine Model. CONCLUSIONS The pursuit of value in connected care is fundamentally the same as with in-person care. Provider organizations, legislators, regulators, and payers face not only a complex task in defining standards and enabling appropriate use, but also a heavy burden of responsibility for unleashing connected care that will benefit the entire community.
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McIntosh S, Cirillo D, Wood N, Dozier AM, Alarie C, McConnochie KM. Patient evaluation of an acute care pediatric telemedicine service in urban neighborhoods. Telemed J E Health 2016; 20:1121-6. [PMID: 25290233 DOI: 10.1089/tmj.2014.0032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Telemedicine has enhanced care for children with illness in Rochester, NY, since May 2001, enabling 13,568 acute illness visits through December 2013. Prior findings included high parent satisfaction with childcare- and school-based telemedicine ("school telemedicine") and potential to replace 85% of office visits for illness. Urban neighborhood telemedicine ("neighborhood telemedicine") was designed to offer convenient care for illness episodes that school telemedicine often cannot serve because illness arises when children are at home or symptoms preclude attendance. This study was designed to characterize health problems prompting neighborhood telemedicine use and to assess parent perceptions of its value. MATERIALS AND METHODS A parent satisfaction instrument was developed with input from parents and providers. Neighborhood telemedicine was initiated in January 2009 and totaled 1,362 visits through November 2013. During a 29-month survey period through January 2012, 3,871 acute illness telemedicine visits were completed, 908 (23.5%) of them via neighborhood telemedicine. Instruments were completed for 392 (43.2%) of the 908 visits. RESULTS Neighborhood telemedicine comprised 27% of all telemedicine visits during the year of peak neighborhood activity. Almost all survey respondents were satisfied or highly satisfied with neighborhood visits (97.6%) and endorsed greater convenience than alternatives (94.5%). CONCLUSIONS Family preferences and the high value placed on neighborhood telemedicine suggest such service is important, especially in health systems driven by patient values. Service provided by neighborhood telemedicine holds potential to meet a large demand for care of acute childhood illness. Financing reform to support patient-centered care (e.g., bundled payments) should encompass sustainable business models for this service.
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Affiliation(s)
- Scott McIntosh
- 1 Division of Social and Behavioral Sciences, Department of Public Health Sciences, University of Rochester Medical Center , Rochester, New York
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A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities. Int J Med Inform 2016; 97:171-194. [PMID: 27919377 DOI: 10.1016/j.ijmedinf.2016.10.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/30/2016] [Accepted: 10/12/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The adoption of telemedicine into mainstream health services has been slower than expected. Many telemedicine projects tend not to progress beyond the trial phase; there are a large number of pilot or project publications and fewer 'service' publications. This issue has been noted since 1999 and continues to be acknowledged in the literature. While overall telemedicine uptake has been slow, some services have been successful. The reporting and evaluation of these successful services may help to improve future uptake and sustainability. The aim of this literature review was to identify peer-reviewed publications of deployed telemedicine services in hospital facilities; and to report, and appraise, the methodology used to evaluate these services. METHODS Computerised literature searches of bibliographic databases were performed using the MeSH terms for "Telemedicine" and "Hospital Services" or "Hospital", for papers published up to May 2016. RESULTS A total of 164 papers were identified, representing 137 telemedicine services. The majority of reported telemedicine services were based in the United States of America (n=61, 44.5%). Almost two thirds of the services (n=86, 62.7%) were delivered by real time telemedicine. Of the reviewed studies, almost half (n=81, 49.3%) assessed their services from three different evaluation perspectives: clinical outcomes, economics and satisfaction. While the remaining half (n=83, 50.6%) described their service and its activities without reporting any evaluation measures. Only 30 (18.2%) studies indicated a two-step implementation and evaluation process. There was limited information in all reported studies regarding description of a structured planning strategy. CONCLUSION Our systematic review identified only 137 telemedicine services. This suggests either telemedicine service implementation is still not a part of mainstream clinical services, or it is not being reported in the peer-reviewed literature. The depth and the quality of information were variable across studies, reducing the generalisability. The reporting of service implementation and planning strategies should be encouraged. Given the fast paced technology driven environment of telemedicine, this may enable others to learn and understand how to implement sustainable services. The key component of planning was underreported in these studies. Studies applying and reporting more rigorous methodology would contribute greatly to the evidence for telemedicine.
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Cormack CL, Garber K, Cristaldi K, Edlund B, Dodds C, McElligott L. Implementing school based telehealth for children with medical complexity. J Pediatr Rehabil Med 2016; 9:237-40. [PMID: 27612084 DOI: 10.3233/prm-160385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This quality improvement project aimed to improve parental experiences with healthcare delivery and collaborative health care offered at a school serving children with medical complexity (CMC) by implementing telehealth services. METHODS Parents of students at an urban public charter school for CMC were surveyed before and after telehealth was implemented at the school for two months, and again one year later, using the Measure of Processes of Care (MPOC-20). RESULTS Parental scores on the MPOC-20 were generally high both before and after the implementation of telehealth. There were no significant differences in the scores. Anecdotally, parent satisfaction with telehealth services was high. A review of the utilization of school-based telehealth during the 2015-2016 school year among 13 schools, including this unique school for CMC, revealed that the odds of having a telehealth visit at the school for CMC vs the other 12 schools was 23.8 (p value < 0.001; CL:11.2 to 50.6). CONCLUSION Parental experiences with healthcare delivery were high both before and after the implementation of telehealth at an urban public charter school for CMC. Utilization of telehealth at the school for CMC was significantly higher than that of children enrolled in the program at 12 other schools. Further research is needed to evaluate parental experiences with school-based telehealth services.
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Affiliation(s)
- Carrie L Cormack
- Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Kelli Garber
- Medical University of South Carolina (MUSC), Charleston, SC, USA
| | | | - Barbara Edlund
- Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Cindy Dodds
- Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Liah McElligott
- Royal College of Surgeons in Ireland Beaumont Hospital, Beaumont, Dublin, Ireland
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Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations. J Am Med Dir Assoc 2016; 17:519-24. [PMID: 26969534 DOI: 10.1016/j.jamda.2016.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Potentially avoidable hospitalizations (PAHs) of nursing home (NH) residents are common, costly, and can have significant economic consequences. Telemedicine has been shown to reduce emergency department and hospitalization of NH residents, yet adoption has been limited and little is known about provider's perceptions and desired functionality for a telemedicine program. The goal of this study was to survey a nationally representative sample of NH physicians and advanced practice providers to quantify provider perceptions and desired functionality of telemedicine in NHs to reduce PAHs. DESIGN/SETTING/PARTICIPANTS/MEASUREMENT We surveyed physicians and advanced practice providers who attended the 2015 AMDA-The Society for Post-Acute and Long-Term Care Medicine Annual Conference about their perceptions of telemedicine and desired attributes of a telemedicine program for managing acute changes of condition associated with PAHs. RESULTS We received surveys from 435 of the 947 conference attendees for a 45.9% response rate. Providers indicated strong agreement with the potential for telemedicine to improve timeliness of care and fill existing service gaps, while disagreeing most with the ideas that telemedicine would reduce care effectiveness and jeopardize resident privacy. Responses indicated clear preferences for the technical requirements of such a program, such as high-quality audio and video and inclusion of an electronic stethoscope, but with varying opinions about who should be performing the consults. CONCLUSION Among NH providers, there is a high degree of confidence in the potential for a telemedicine solution to PAHs in NHs, as well as concrete views about features of such a solution. Such consensus could be used to drive an approach to telemedicine for PAHs in NHs that retains the theoretical strengths of telemedicine and reflects the needs of facilities, providers, and patients. Further research is needed to objectively study the impact of successful telemedicine implementations on patient, provider, and economic outcomes.
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Abstract
OBJECTIVE The aim of this study was to review current literature relating to telemedicine in pediatric emergency medicine including its clinical applications and challenges associated with its implementation. METHODS We reviewed the literature using standard search methods in accordance with preferred reporting items for systematic reviews and meta-analysis. We included the studies done in emergency settings for all age groups and narrowed our search to the articles that are relevant to "impact on quality of care" and "patient outcome." We also described current telemedicine uses, software, hardware, and other requirements needed for pediatric emergency applications. RESULTS Telemedicine has a potential role in pediatric emergency medicine for real-time decision making to improve quality of care for children. Logistic and legal challenges exist for pediatric emergency medicine applications similar to its uses in other settings. CONCLUSIONS Current frameworks exist in the use of telemedicine for pediatric emergency medicine. Research is still needed to see whether clinical outcomes are improved with pediatric emergency telemedicine solutions. Practical issues regarding training, accessibility, and resource allocation should be explored as pediatric emergency telemedicine evolves.
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Gillespie SM, Shah MN, Wasserman EB, Wood NE, Wang H, Noyes K, Nelson D, Dozier A, McConnochie KM. Reducing Emergency Department Utilization Through Engagement in Telemedicine by Senior Living Communities. Telemed J E Health 2016; 22:489-96. [PMID: 26741194 DOI: 10.1089/tmj.2015.0152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High-intensity telemedicine has been shown to reduce the need for emergency department (ED) care for older adult senior living community (SLC) residents with acute illnesses. We evaluated the effect of SLC engagement in the telemedicine program on ED use rates. MATERIALS AND METHODS We performed a secondary analysis of data from a prospective cohort study evaluating the effectiveness of high-intensity telemedicine for SLC residents. We compared the annual rate of change in ED use among subjects who resided in SLC units that were more engaged in telemedicine services with that among subjects who resided in SLC units that were less engaged in telemedicine and control subjects who lived at facilities without access to telemedicine services. RESULTS During the study, subjects had 503 telemedicine visits, with 362 (72.0%) in the more engaged SLCs and 141 (28.0%) in the less engaged SLCs. For subjects residing in more engaged SLCs, ED use decreased at an annualized rate of 28% (rate ratio [RR] = 0.72; 95% confidence interval [CI], 0.58-0.89), whereas in the less engaged (RR = 0.962; 95% CI, 0.776-1.19) and control (RR = 0.909, 95% CI, 0.822-1.07) groups there was no significant change in ED use (p = 0.036 for group × time interaction). CONCLUSIONS Individuals residing in more engaged SLCs experienced a greater decrease in ED use compared with subjects residing in less engaged SLCs or those without access to high-intensity telemedicine for acute illnesses. We identified potential factors associated with more engaged SLCs, but further research is needed to understand resident and staff engagement and how to increase it.
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Affiliation(s)
- Suzanne M Gillespie
- 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.,2 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Manish N Shah
- 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.,2 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.,3 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Erin B Wasserman
- 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.,3 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Nancy E Wood
- 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Hongyue Wang
- 4 Department of Biostatistics, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Katia Noyes
- 3 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.,5 Department of Surgery, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Dallas Nelson
- 2 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Ann Dozier
- 3 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Kenneth M McConnochie
- 6 Department of Pediatrics, University of Rochester School of Medicine and Dentistry , Rochester, New York
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Marcin JP, Shaikh U, Steinhorn RH. Addressing health disparities in rural communities using telehealth. Pediatr Res 2016; 79:169-76. [PMID: 26466080 DOI: 10.1038/pr.2015.192] [Citation(s) in RCA: 203] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/29/2015] [Indexed: 11/10/2022]
Abstract
The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists' geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.
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Affiliation(s)
- James P Marcin
- Department of Pediatrics, University of California-Davis School of Medicine, Sacramento, California
| | - Ulfat Shaikh
- Department of Pediatrics, University of California-Davis School of Medicine, Sacramento, California
| | - Robin H Steinhorn
- Department of Pediatrics, University of California-Davis School of Medicine, Sacramento, California
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Shah MN, Wasserman EB, Gillespie SM, Wood NE, Wang H, Noyes K, Nelson D, Dozier A, McConnochie KM. High-Intensity Telemedicine Decreases Emergency Department Use for Ambulatory Care Sensitive Conditions by Older Adult Senior Living Community Residents. J Am Med Dir Assoc 2015; 16:1077-81. [PMID: 26293419 DOI: 10.1016/j.jamda.2015.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 06/29/2015] [Accepted: 07/08/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) are common among older adults. The high-intensity telemedicine model of care has been proposed as an innovative approach to expand access to acute illness care, thereby preventing ED visits. The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of ED use for ACSCs. METHODS We performed a prospective cohort study at a primary care geriatrics practice that provides care to 22 SLCs. Six SLCs selected as intervention facilities, with the remaining SLCs serving as controls. Consenting practice patients at intervention facilities could have patient-to-provider, real-time, or store-and-forward high-intensity telemedicine services to diagnose and treat illnesses. The primary outcome was the rate of ED visits for which the primary diagnosis was an "ambulatory-care-sensitive" condition by the Institute of Medicine, which we compared between control and intervention participants. RESULTS During the study period, control participants had 310 ED visits for ACSCs, for a rate of 0.195 visits/person-year. Intervention participants visited the ED for ACSCs 85 times, for a rate of 0.138 visits/person-year [unadjusted rate ratio (RR): 0.71, 95% confidence interval (CI): 0.53-0.94]. Among intervention participants, ED use for ACSCs decreased at an annual rate of 34% (RR: 0.661, 95% CI: 0.444-0.982), whereas, in the control group there was no statistically significant change in ED use over time (RR: 1.01, 95% CI: 0.90-1.14). CONCLUSIONS Providing acute illness care by high-intensity telemedicine to older adults residing in SLCs significantly decreases the rate of ED use for ACSCs over 1 year, compared with no change in the rate of ED use for ACSCs among the control group.
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Affiliation(s)
- Manish N Shah
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Erin B Wasserman
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Suzanne M Gillespie
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Nancy E Wood
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Katia Noyes
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Dallas Nelson
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kenneth M McConnochie
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Shah MN, Wasserman EB, Wang H, Gillespie SM, Noyes K, Wood NE, Nelson D, Dozier A, McConnochie KM. High-Intensity Telemedicine Decreases Emergency Department Use by Senior Living Community Residents. Telemed J E Health 2015; 22:251-8. [PMID: 26252866 DOI: 10.1089/tmj.2015.0103] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The failure to provide timely acute illness care can lead to adverse consequences or emergency department (ED) use. We evaluated the effect on ED use of a high-intensity telemedicine program that provides acute illness care for senior living community (SLC) residents. MATERIALS AND METHODS We performed a prospective cohort study over 3.5 years. Six SLCs cared for by a primary care geriatrics practice were intervention facilities, with the remaining 16 being controls. Consenting patients at intervention facilities could access telemedicine for acute illness care. Patients were provided patient-to-provider, real-time, or store-and-forward high-intensity telemedicine (i.e., technician-assisted with resources beyond simple videoconferencing) to diagnose and treat acute illnesses. The primary outcome was the rate of ED use. RESULTS We enrolled 494 of 705 (70.1%) subjects/proxies in the intervention group; 1,058 subjects served as controls. Control and intervention subjects visited the ED 2,238 and 725 times, respectively, with 47.3% of control and 43.4% of intervention group visits resulting in discharge home. Among intervention subjects, ED use decreased at an annualized rate of 18% (rate ratio [RR]=0.82; 95% confidence interval [CI], 0.70-0.95), whereas in the control group there was no statistically significant change in ED use (RR=1.01; 95% CI, 0.95-1.07; p=0.009 for group-by-time interaction). Primary care use and mortality were not significantly different. CONCLUSIONS High-intensity telemedicine significantly reduced ED use among SLC residents without increasing other utilization or mortality. This alternative to traditional acute illness care can enhance access to acute illness care and should be integrated into population health programs.
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Affiliation(s)
- Manish N Shah
- 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.,2 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.,3 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Erin B Wasserman
- 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.,2 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Hongyue Wang
- 4 Department of Biostatistics, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Suzanne M Gillespie
- 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York.,3 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Katia Noyes
- 2 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York.,5 Department of Surgery, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Nancy E Wood
- 1 Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Dallas Nelson
- 3 Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Ann Dozier
- 2 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Kenneth M McConnochie
- 6 Department of Pediatrics, University of Rochester School of Medicine and Dentistry , Rochester, New York
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McConnochie KM, Ronis SD, Wood NE, Ng PK. Effectiveness and Safety of Acute Care Telemedicine for Children with Regular and Special Healthcare Needs. Telemed J E Health 2015; 21:611-21. [DOI: 10.1089/tmj.2014.0175] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kenneth M. McConnochie
- Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Sarah D. Ronis
- Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Nancy E. Wood
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Phillip K. Ng
- Information Services Division, University of Rochester Medical Center, Rochester, New York
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Marcin JP, Rimsza ME, Moskowitz WB. The Use of Telemedicine to Address Access and Physician Workforce Shortages. Pediatrics 2015; 136:202-9. [PMID: 26122802 DOI: 10.1542/peds.2015-1253] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists (henceforth referred to as "pediatric physicians") has the potential to transform the practice of pediatrics. The purpose of this policy statement is to describe the expected and potential impact that telemedicine will have on pediatric physicians' efforts to improve access and physician workforce shortages. The policy statement also describes how the American Academy of Pediatrics can advocate for its members and their patients to best use telemedicine technologies to improve access to care, provide more patient- and family-centered care, increase efficiencies in practice, enhance the quality of care, and address projected shortages in the clinical workforce. As the use of telemedicine increases, it is likely to impact health care access, quality, and education and costs of care. Telemedicine technologies, applied to the medical home and its collaborating providers, have the potential to improve current models of care by increasing communication among clinicians, resulting in more efficient, higher quality, and less expensive care. Such a model can serve as a platform for providing more continuous care, linking primary and specialty care to support management of the needs of complex patients. In addition, telemedicine technologies can be used to efficiently provide pediatric physicians working in remote locations with ongoing medical education, increasing their ability to care for more complex patients in their community, reducing the burdens of travel on patients and families, and supporting the medical home. On the other hand, telemedicine technologies used for episodic care by nonmedical home providers have the potential to disrupt continuity of care and to create redundancy and imprudent use of health care resources. Fragmentation should be avoided, and telemedicine, like all primary and specialty services, should be coordinated through the medical home.
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Abstract
Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine's current use bears testimony to its effectiveness and potential. Telemedicine's widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits.
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Hwang U, Shah MN, Han JH, Carpenter CR, Siu AL, Adams JG. Transforming emergency care for older adults. Health Aff (Millwood) 2015; 32:2116-21. [PMID: 24301394 DOI: 10.1377/hlthaff.2013.0670] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Already crowded and stressful, US emergency departments (EDs) are facing the challenge of serving an aging population that requires complex and lengthy evaluations. Creative solutions are necessary to improve the value and ensure the quality of emergency care delivered to older adults while more fully addressing their complex underlying physical, social, cognitive, and situational needs. Developing models of geriatric emergency care, including some that are already in use at dedicated geriatric EDs, incorporate a variety of physical, procedural, and staffing changes. Among the options for "geriatricizing" emergency care are approaches that may eliminate the need for an ED visit, such as telemedicine; for initial hospitalization, such as patient observation units; and for rehospitalization, such as comprehensive discharge planning. By transforming their current safety-net role to becoming a partner in care coordination, EDs have the opportunity to become better integrated into the broader health care system, improve patient health outcomes, contribute to optimizing the health care system, and reduce overall costs of care-keys to improving emergency care for patients of all ages.
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Skranes LP, Løhaugen GCC, Skranes J. A child health information website developed by physicians: the impact of use on perceived parental anxiety and competence of Norwegian mothers. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0659-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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