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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Talay L, Alvi O. Digital healthcare solutions to better achieve the weight loss outcomes expected by payors and patients. Diabetes Obes Metab 2024; 26:2521-2523. [PMID: 38379435 DOI: 10.1111/dom.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Louis Talay
- University of Sydney SDN, Randwick, New South Wales, Australia
| | - Omar Alvi
- Eucalyptus VC, Sydney, New South Wales, Australia
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Lazic A, Tilford JM, Davis VP, Brown CC. Association of copayments with healthcare utilization and expenditures among Medicaid enrollees with a substance use disorder. J Subst Use Addict Treat 2024; 161:209314. [PMID: 38369244 PMCID: PMC11090739 DOI: 10.1016/j.josat.2024.209314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The purpose of this study was to examine the association between copayments and healthcare utilization and expenditures among Medicaid enrollees with substance use disorders. METHODS This study used claims data (2020-2021) from a private insurer participating in Arkansas's Medicaid expansion. We compared service utilization and expenditures for enrollees in different Medicaid program structures with varying copayments. Enrollees with incomes above 100 % FPL (N = 10,240) had copayments for substance use treatment services while enrollees below 100 % FPL (N = 2478) did not. Demographic, diagnostic, utilization, and cost information came from claims and enrollment information. The study identified substance use and clinical comorbidities using claims from July through December 2020 and evaluated utilization and costs in 2021. Generalized linear models (GLM) estimated outcomes using single equation and two-part modeling. A gamma distribution and log link were used to model expenditures, and negative binomial models were used to model utilization. A falsification test comparing behavioral health telemedicine utilization, which had no cost sharing in either group, assessed whether differences in the groups may be responsible for observed findings. RESULTS Substance use enrollees with copayments were less likely to have a substance use or behavioral health outpatient (-0.04 PP adjusted; p = 0.001) or inpatient visit (-0.04 PP; p = 0.001) relative to their counterparts without copayments, equal to a 17 % reduction in substance use or behavioral health outpatient services and a nearly 50 % reduction in inpatient visits. The reduced utilization among enrollees with a copayment was associated with a significant reduction in total expenses ($954; p = 0.001) and expenses related to substance use or behavioral health services ($532; p = 0.001). For enrollees with at least one behavioral health visit, there were no differences in outpatient or inpatient utilization or expenditures between enrollees with and without copayments. Copayments had no association with non-behavioral health or telemedicine services where neither group had cost sharing. CONCLUSION Copayments serve as an initial barrier to substance use treatment, but are not associated with the amount of healthcare utilization conditional on using services. Policy makers and insurers should consider the role of copayments for treatment services among enrollees with substance use disorders in Medicaid programs.
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Affiliation(s)
- Antonije Lazic
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - J Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - Victor P Davis
- Actuarial Services & Enterprise Underwriting, Arkansas Blue Cross Blue Shield, Little Rock, AR 72201, USA
| | - Clare C Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA.
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Cummins MR, Shishupal S, Wong B, Wan N, Han J, Johnny JD, Mhatre-Owens A, Gouripeddi R, Ivanova J, Ong T, Soni H, Barrera J, Wilczewski H, Welch BM, Bunnell BE. Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study. J Med Internet Res 2024; 26:e53437. [PMID: 38536065 DOI: 10.2196/53437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/22/2023] [Accepted: 01/26/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Digital health and telemedicine are potentially important strategies to decrease health care's environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. OBJECTIVE This study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants. METHODS We conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States. RESULTS The median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. CONCLUSIONS These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector's carbon footprint.
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Affiliation(s)
- Mollie R Cummins
- College of Nursing, University of Utah, Salt Lake City, UT, United States
- Spencer Fox Eccles School of Medicine, Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
- Doxy.me Inc, Charleston, SC, United States
| | - Sukrut Shishupal
- Spencer Fox Eccles School of Medicine, Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Neng Wan
- Department of Geography, University of Utah, Salt Lake City, UT, United States
| | - Jiuying Han
- Department of Geography, University of Utah, Salt Lake City, UT, United States
| | - Jace D Johnny
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Amy Mhatre-Owens
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Ramkiran Gouripeddi
- Spencer Fox Eccles School of Medicine, Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | | | - Triton Ong
- Doxy.me Inc, Charleston, SC, United States
| | - Hiral Soni
- Doxy.me Inc, Charleston, SC, United States
| | - Janelle Barrera
- Doxy.me Inc, Charleston, SC, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Salt Lake City, UT, United States
| | | | - Brandon M Welch
- Doxy.me Inc, Charleston, SC, United States
- Medical University of South Carolina, Charleston, SC, United States
| | - Brian E Bunnell
- Doxy.me Inc, Charleston, SC, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Salt Lake City, UT, United States
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Nakamoto CH, Cutler DM, Beaulieu ND, Uscher-Pines L, Mehrotra A. The Impact Of Telemedicine On Medicare Utilization, Spending, And Quality, 2019-22. Health Aff (Millwood) 2024; 43:691-700. [PMID: 38630943 DOI: 10.1377/hlthaff.2023.01142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Telemedicine use remains substantially higher than it was before the COVID-19 pandemic, although it has fallen from pandemic highs. To inform the ongoing debate about whether to continue payment for telemedicine visits, we estimated the association of greater telemedicine use across health systems with utilization, spending, and quality. In 2020, Medicare patients receiving care at health systems in the highest quartile of telemedicine use had 2.5 telemedicine visits per person (26.8 percent of visits) compared with 0.7 telemedicine visits per person (9.5 percent of visits) in the lowest quartile of telemedicine use. In 2021-22, relative to those in the lowest quartile, Medicare patients of health systems in the highest quartile had an increase of 0.21 total outpatient visits (telemedicine and in-person) per patient per year (2.2 percent relative increase), a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7 percent relative decrease), a $248 increase in per patient per year spending (1.6 percent relative increase), and increased adherence for metformin and statins. There were no clear differential changes in hospitalizations or receipt of preventive care.
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Affiliation(s)
| | - David M Cutler
- David M. Cutler, Harvard University and National Bureau of Economic Research, Cambridge, Massachusetts
| | | | | | - Ateev Mehrotra
- Ateev Mehrotra , Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Prosperi Desenzi Ciaralo P, Guerreiro Cardoso PF, Minamoto H, Bibas BJ, Ribeiro de Carvalho CR, Pego-Fernandes PM. Implementation and Results of a Dedicated Telemedicine Program ( TeleTrachea) for Patients with Tracheal Diseases. Telemed J E Health 2024; 30:1317-1324. [PMID: 38109228 DOI: 10.1089/tmj.2023.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Background: Central airway diseases requiring frequent outpatient visits to a specialized medical center due to tracheal devices. Many of these patients have mobility and cognition restrictions or require specialized transport due to the need for supplemental oxygen. This study describes the implementation and results of a telemedicine program dedicated to patients with central airway diseases based in a Brazilian public health system. Methods: A retrospective study of telemedicine consultation for patients with central airway diseases referred to a public academic hospital between August 1, 2020 and August 1, 2022. The consultations occurred in a telemedicine department using the hospital's proprietary platform. Data retrieved consisted of demographics, disease characteristics, and the treatment modalities of the patients. The analysis included the savings in kilometers not traveled, the carbon footprint based on reducing CO2 emissions, and the cost savings in transportation. Results: A total of 1,153 telemedicine visits conducted in 516 patients (median age of 31.5 years). Two hundred ninety patients (56.2%) had a tracheal device (129 silicone T-Tube, 128 tracheostomy, and 33 endoprosthesis) and 159 patients (30.8%) had difficulties in transportation to the specialized medical center. Patients were served from 147 Brazilian cities from 22 states. The savings in kilometers traveled was 1,224,108.54 km, corresponding to a 250.14 ton reduction in CO2 emissions. The costs savings in transportation for the municipalities was BRL$ 1,272,283.78. Conclusions: Telemedicine consultations for patients with central airway diseases are feasible and safe. Cost savings and the possibility of disseminating specialized care make telemedicine a fundamental tool in current medical practice.
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Affiliation(s)
- Pedro Prosperi Desenzi Ciaralo
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Helio Minamoto
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Benoit Jacques Bibas
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Divisions of Pulmonology, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Manuel Pego-Fernandes
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
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Lee JS, Bhatt A, Pollack LM, Jackson SL, Omeaku N, Beasley KL, Wilson C, Luo F, Roy K. Racial and Ethnic Differences in Hypertension-Related Telehealth and In-Person Outpatient Visits Before and During the COVID-19 Pandemic Among Medicaid Beneficiaries. Telemed J E Health 2024; 30:1262-1271. [PMID: 38241486 PMCID: PMC11065593 DOI: 10.1089/tmj.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Background: Little is known about the trends and costs of hypertension management through telehealth among individuals enrolled in Medicaid. Methods: Using MarketScan® Medicaid database, we examined outpatient visits among people with hypertension aged 18-64 years. We presented the numbers of hypertension-related telehealth and in-person outpatient visits per 100 individuals and the proportion of hypertension-related telehealth outpatient visits to total outpatient visits by month, overall, and by race and ethnicity. For the cost analysis, we presented total and patient out-of-pocket (OOP) costs per visit for telehealth and in-person visits in 2021. Results: Of the 229,562 individuals, 114,445 (49.9%) were non-Hispanic White, 80,692 (35.2%) were non-Hispanic Black, 3,924 (1.71%) were Hispanic. From February to April 2020, the number of hypertension-related telehealth outpatient visits per 100 persons increased from 0.01 to 6.13, the number of hypertension-related in-person visits decreased from 61.88 to 52.63, and the proportion of hypertension-related telehealth outpatient visits increased from 0.01% to 10.44%. During that same time, the proportion increased from 0.02% to 13.9% for non-Hispanic White adults, from 0.00% to 7.58% for non-Hispanic Black adults, and from 0.12% to 19.82% for Hispanic adults. The average total and patient OOP costs per visit in 2021 were $83.82 (95% confidence interval [CI], 82.66-85.05) and $0.55 (95% CI, 0.42-0.68) for telehealth and $264.48 (95% CI, 258.87-269.51) and $0.72 (95% CI, 0.65-0.79) for in-person visits, respectively. Conclusions: Hypertension management via telehealth increased among Medicaid recipients regardless of race and ethnicity, during the COVID-19 pandemic. These findings may inform telehealth policymakers and health care practitioners.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami Bhatt
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nina Omeaku
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Prada SI, Toro JJ, Peña-Zárate EE, Libreros-Peña L, Alarcón J, Escobar MF. Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis. BMJ Open 2024; 14:e084447. [PMID: 38692730 PMCID: PMC11086581 DOI: 10.1136/bmjopen-2024-084447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. OBJECTIVE We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. DESIGN A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. SETTING A high-complexity teaching hospital located in Cali, Colombia. PARTICIPANTS Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. OUTCOME MEASURES Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient's perspective. RESULTS A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. CONCLUSION Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.
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Affiliation(s)
- Sergio Iván Prada
- Subdirección de Investigación e Innovación, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
- Centro PROESA, Universidad Icesi, Calle 18 No. 122-135, Cali 760032, Colombia
| | - José Joaquín Toro
- Departamento de Costos y Presupuestos, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
| | - Evelyn E Peña-Zárate
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
| | - Laura Libreros-Peña
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
| | - Juliana Alarcón
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
| | - María Fernanda Escobar
- Unidad de Equidad Global en Salud, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali 760032, Colombia
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Ssegonja R, Ljunggren M, Sampaio F, Tegelmo T, Theorell-Haglöw J. Economic evaluation of telemonitoring as a follow-up approach for patients with obstructive sleep apnea syndrome starting treatment with continuous positive airway pressure. J Sleep Res 2024; 33:e13968. [PMID: 37337981 DOI: 10.1111/jsr.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
Telemonitoring of obstructive sleep apnea patients is increasingly being adopted though its cost-effectiveness evidence base is scanty. This study investigated whether telemonitoring is a cost-effective strategy compared with the standard follow-up in patients with obstructive sleep apnea who are starting continuous positive airway pressure treatment. In total, 167 obstructive sleep apnea patients were randomised into telemonitoring (n = 79) or standard follow-up (n = 88), initiated continuous positive airway pressure treatment, and were followed up for 6 months. The frequencies of healthcare contacts, related costs (in USD 2021 prices), treatment effect and compliance were compared between the follow-up approaches using generalised linear models. The cost effectiveness analysis was conducted from a healthcare perspective and the results presented as cost per avoided extra clinic visit. Additionally, patient satisfaction between the two approaches was explored. The analysis showed no baseline differences. At follow-up, there was no significant difference in treatment compliance, and the mean residual apnea-hypoapnea index. There was no difference in total visits, adjusted incidence rate ratio 0.87 (0.72-1.06). Participants in the telemonitoring arm made eight times more telephone visits, 8.10 (5.04-13.84), and about 73% fewer physical healthcare visits 0.27 (0.20-0.36). This translated into significantly lower total costs for the telemonitoring approach compared with standard follow-up, -192 USD (-346 to -41). The form of follow-up seemed to have no impact on the extent of patient satisfaction. These results demonstrate the telemonitoring of patients with obstructive sleep apnea initiating continuous positive airway pressure treatment as a cost saving strategy and can be argued as a potential worthy investment.
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Affiliation(s)
- Richard Ssegonja
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tove Tegelmo
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
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Saharkhiz M, Rao T, Parker-Lue S, Borelli S, Johnson K, Cataife G. Telehealth Expansion and Medicare Beneficiaries' Care Quality and Access. JAMA Netw Open 2024; 7:e2411006. [PMID: 38739388 DOI: 10.1001/jamanetworkopen.2024.11006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Importance Understanding the association of telehealth use with health care outcomes is fundamental to determining whether telehealth waivers implemented during the COVID-19 public health emergency should be made permanent. The current literature has yielded inconclusive findings owing to its focus on select states, practices, or health care systems. Objective To estimate the association of telehealth use with outcomes for all Medicare fee-for-service (FFS) beneficiaries by comparing hospital service areas (HSAs) with different levels of telehealth use. Design, Setting, and Participants This US population-based, retrospective cohort study was conducted from July 2022 to April 2023. Participants included Medicare claims of beneficiaries attributed to HSAs with FFS enrollment in Parts A and B. Exposures Low, medium, or high tercile of telehealth use created by ranking HSAs according to the number of telehealth visits per 1000 beneficiaries. Main Outcomes and Measures The primary outcomes were quality (ambulatory care-sensitive [ACS] hospitalizations and emergency department [ED] visits per 1000 FFS beneficiaries), access to care (clinician encounters per FFS beneficiary), and cost (total cost of care for Part A and/or B services per FFS Medicare beneficiary) determined with a difference-in-difference analysis. Results In this cohort study of claims from approximately 30 million Medicare beneficiaries (mean [SD] age in 2019, 71.04 [1.67] years; mean [SD] percentage female in 2019, 53.83% [2.14%]) within 3436 HSAs, between the second half of 2019 and the second half of 2021, mean ACS hospitalizations and ED visits declined sharply, mean clinician encounters per beneficiary declined slightly, and mean total cost of care per beneficiary per semester increased slightly. Compared with the low group, the high group had more ACS hospitalizations (1.63 additional hospitalizations per 1000 beneficiaries; 95% CI, 1.03-2.22 hospitalizations), more clinician encounters (0.30 additional encounters per beneficiary per semester; 95% CI, 0.23-0.38 encounters), and higher total cost of care ($164.99 higher cost per beneficiary per semester; 95% CI, $101.03-$228.96). There was no statistically significant difference in ACS ED visits between the low and high groups. Conclusions and Relevance In this cohort study of Medicare beneficiaries across all 3436 HSAs, high levels of telehealth use were associated with more clinician encounters, more ACS hospitalizations, and higher total health care costs. COVID-19 cases were still high during the period of study, which suggests that these findings partially reflect a higher capacity for providing health services in HSAs with higher telehealth intensity than other HSAs.
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Affiliation(s)
| | - Tanvi Rao
- American Institutes for Research, Arlington, Virginia
| | | | - Sara Borelli
- American Institutes for Research, Arlington, Virginia
| | - Karin Johnson
- American Institutes for Research, Arlington, Virginia
| | - Guido Cataife
- American Institutes for Research, Arlington, Virginia
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Bell JM, Dwyer TJ, Cunich M, Dentice RL, Hutchings O, Jo HE, Lau EM, Lee WY, Nolan SA, Munoz P, Raffan F, Shah K, Shaw M, Taylor NA, Visser SK, Yozghatlian VA, Wong KKH, Sivam S. Impact of cystic fibrosis multidisciplinary virtual clinics on patient experience, time commitments and costs. Intern Med J 2024; 54:809-816. [PMID: 37886890 DOI: 10.1111/imj.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND AIMS The experience of outpatient care may differ for select patient groups. This prospective study evaluates the adult patient experience of multidisciplinary outpatient cystic fibrosis (CF) care with videoconferencing through telehealth compared with face-to-face care the year prior. METHODS People with CF without a lung transplant were recruited. Patient-reported outcomes were obtained at commencement and 12 months into the study, reflecting both their face-to-face and telehealth through videoconferencing experience, respectively. Three patient cohorts were analysed: (i) participants with a regional residence, (ii) participants with a nonregional including metropolitan residence and (iii) participants with colonised multiresistant microbiota. RESULTS Seventy-four patients were enrolled in the study (mean age, 37 ± 11 years; 50% male; mean forced expiratory volume in the first second of expiration, 60% [standard deviation, 23]) between February 2020 and May 2021. No differences between models were observed in the participants' rating of the health care team, general and mental health rating, and their confidence in handling treatment plans at home. No between-group differences in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) were observed. Travel duration and the cost of attending a clinic was significantly reduced, particularly for the regional group (4 h, AU$108 per clinic; P < 0.05). A total of 93% respondents preferred to continue with a hybrid approach. CONCLUSION In this pilot study, participants' experience of care and quality of life were no different with face-to-face and virtual care between the groups. Time and cost-savings, particularly for patients living in regional areas, were observed. Most participants preferred to continue with a hybrid model for outpatient care.
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Affiliation(s)
- Jody M Bell
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | - Tiffany J Dwyer
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Cunich
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
- Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia
| | - Ruth L Dentice
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | | | - Helen E Jo
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | - Edmund M Lau
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | - Wai Y Lee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Samantha A Nolan
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Phillip Munoz
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | | | - Karishma Shah
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | - Nicole A Taylor
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Simone K Visser
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | - Veronica A Yozghatlian
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | - Keith K H Wong
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
| | - Sheila Sivam
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia
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12
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Wallace MM, Hackstadt AJ, Zhao Z, Patrinely JR, Zic J, Ellis D, Paul L, Sultan M, Danford B, Hanlon AM. The Teledermatology Experience: Cost Savings and Image Quality Control. Telemed J E Health 2024; 30:1411-1417. [PMID: 38150704 DOI: 10.1089/tmj.2022.0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction: Teledermatology adoption continues to increase, in part, spurred by the COVID-19 pandemic. This study analyzes the utility and cost savings of a store-and-forward teledermatology consultative system within the Veterans Health Administration (VA). Methods: Retrospective cohort of 4,493 patients across 14 remote sites in Tennessee and Kentucky from May 2017 through August 2019. The study measured the agreement between the teledermatology diagnoses and follow-up face-to-face clinic evaluations as well as the cost effectiveness of the teledermatology program over the study period. Results: Fifty-four percent of patients were recommended for face-to-face appointment for biopsy or further evaluation. Most patients, 80.5% received their face-to-face care by a VA dermatologist. There was a high level of concordance between teledermatologist and clinic dermatologist for pre-malignant and malignant cutaneous conditions. Veterans were seen faster at a VA clinic compared with a community dermatology site. Image quality improved as photographers incorporated teledermatologist feedback. From a cost perspective, teledermatology saved the VA system $1,076,000 in community care costs. Discussion: Teledermatology is a useful diagnostic tool within the VA system providing Veteran care at a cost savings.
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Affiliation(s)
- Matthew M Wallace
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amber J Hackstadt
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Zijun Zhao
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - John Zic
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Darrel Ellis
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lynn Paul
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miliyard Sultan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brandon Danford
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Allison M Hanlon
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Kennedy KL, Kong WY, Heisler-MacKinnon J, Medlin R, Loughlin CE, Lawler CN, Hernandez ML, Galbraith AA, Gilkey MB. Using Cost Conversations to Address Financial Toxicity in Pediatric Asthma Care: Findings From a Survey of Caregivers. J Pediatr Health Care 2024; 38:374-381. [PMID: 38043046 DOI: 10.1016/j.pedhc.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/05/2023] [Accepted: 10/26/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Asthma care teams are well-positioned to help caregivers address financial toxicity in pediatric asthma care, although discussing cost can be challenging. We sought to characterize cost conversations in pediatric asthma specialty care. METHOD We surveyed 45 caregivers of children aged 4-17 with asthma. Eligible caregivers reported costs concerns and had accompanied their child to a multisite asthma specialty practice in North Carolina. RESULTS About one-third of caregivers reported a cost conversation (36%). Cost conversations were less common among caregivers whose child had public versus private health insurance (16% vs. 56%), who attended a telehealth versus in-person visit (6% vs. 52%), or who did not versus did want a conversation (19% vs. 77%, all p < .05). Common cost conversation topics were medications and equipment like spacers. DISCUSSION Our findings suggest cost conversations may be relatively uncommon in pediatric asthma care, particularly for publicly insured patients and telehealth visits.
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14
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Patel N, Loveland J, Scribante J. Telephonic follow-up after day case pediatric surgery in an upper middle income country: A pilot study. World J Surg 2024; 48:1266-1270. [PMID: 38441293 DOI: 10.1002/wjs.12129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/27/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND One third of South African children live in households with no employed adult. Telemedicine may save patients and the strained public health sector significant resources. We aimed to determine the safety and benefits of telephonic post-operative follow-up of patients who presented for day case surgery at CHBAH from 1 January-31 March 2023. METHODS A prospective descriptive study on patients undergoing day case surgery was performed. Healthy patients greater than 6 years old whose caregivers spoke English and had access to a smartphone were included. Data on the total number of telephonic follow-ups, operative complications, need for in person review, satisfaction with telephonic follow-up, and savings in transport costs and time by avoiding in person follow-up were collected. RESULTS A total of 38 telephonic follow-ups were performed. Six (15.8%) patients presented for in person review due to the detection of major complications (2, 5.3%), minor complications (2, 5.3%), and parental concern (2, 5.3%) during telephonic follow-up. All caregivers reported being satisfied with telephonic follow-up. Total savings in transport costs were R4452 (US $ 248.45). The majority of patients (29, 76.3%) had at least one unemployed parent. Seven caregivers (18.4%) avoided taking paid leave and 2 (5.3%) unpaid leave from work due to follow-up being performed telephonically. CONCLUSIONS Innovation is necessary in order to expand access to safe, affordable, and timely care. In this selected group, telephonic follow-up was a safe, acceptable, and cost-effective intervention. The expansion of such a program has the potential for significant savings for patients and the healthcare system.
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Affiliation(s)
- Nirav Patel
- Department of Paediatric Surgery, Faculty of Health Sciences, School of Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Surgeons for Little Lives, Johannesburg, South Africa
| | - Jerome Loveland
- Department of Paediatric Surgery, Faculty of Health Sciences, School of Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Surgeons for Little Lives, Johannesburg, South Africa
- Department of Transplant Surgery, Faculty of Health Sciences, School of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Juan Scribante
- Department of Paediatric Surgery, Faculty of Health Sciences, School of Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Surgeons for Little Lives, Johannesburg, South Africa
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15
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Wu X, Wu Y, Tu Z, Cao Z, Xu M, Xiang Y, Lin D, Jin L, Zhao L, Zhang Y, Liu Y, Yan P, Hu W, Liu J, Liu L, Wang X, Wang R, Chen J, Xiao W, Shang Y, Xie P, Wang D, Zhang X, Dongye M, Wang C, Ting DSW, Liu Y, Pan R, Lin H. Cost-effectiveness and cost-utility of a digital technology-driven hierarchical healthcare screening pattern in China. Nat Commun 2024; 15:3650. [PMID: 38688925 PMCID: PMC11061155 DOI: 10.1038/s41467-024-47211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
Utilization of digital technologies for cataract screening in primary care is a potential solution for addressing the dilemma between the growing aging population and unequally distributed resources. Here, we propose a digital technology-driven hierarchical screening (DH screening) pattern implemented in China to promote the equity and accessibility of healthcare. It consists of home-based mobile artificial intelligence (AI) screening, community-based AI diagnosis, and referral to hospitals. We utilize decision-analytic Markov models to evaluate the cost-effectiveness and cost-utility of different cataract screening strategies (no screening, telescreening, AI screening and DH screening). A simulated cohort of 100,000 individuals from age 50 is built through a total of 30 1-year Markov cycles. The primary outcomes are incremental cost-effectiveness ratio and incremental cost-utility ratio. The results show that DH screening dominates no screening, telescreening and AI screening in urban and rural China. Annual DH screening emerges as the most economically effective strategy with 341 (338 to 344) and 1326 (1312 to 1340) years of blindness avoided compared with telescreening, and 37 (35 to 39) and 140 (131 to 148) years compared with AI screening in urban and rural settings, respectively. The findings remain robust across all sensitivity analyses conducted. Here, we report that DH screening is cost-effective in urban and rural China, and the annual screening proves to be the most cost-effective option, providing an economic rationale for policymakers promoting public eye health in low- and middle-income countries.
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Affiliation(s)
- Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yuxuan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Zhenjun Tu
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zizheng Cao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Miaohong Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yingzhe Zhang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yu Liu
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Pisong Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Weiling Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Jiali Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Lixue Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Jieying Chen
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yuanjun Shang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Peichen Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Dongni Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xulin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Meimei Dongye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Chenxinqi Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China.
| | - Rong Pan
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China.
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan, China.
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Zakiyah N, Marulin D, Alfaqeeh M, Puspitasari IM, Lestari K, Lim KK, Fox-Rushby J. Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review. J Med Internet Res 2024; 26:e53500. [PMID: 38687991 PMCID: PMC11094606 DOI: 10.2196/53500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. OBJECTIVE This study's objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. METHODS A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. RESULTS Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48%), trials (13/27, 48%), or a combination approach (1/27, 4%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89%) used cost-utility analysis. The majority of the studies (25/27, 93%) were conducted in high-income countries, particularly European countries (16/27, 59%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74%), moderate (6/27, 22%), or excellent (1/27, 4%). CONCLUSIONS Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. TRIAL REGISTRATION PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc.
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Affiliation(s)
- Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Dita Marulin
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Mohammed Alfaqeeh
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Irma Melyani Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Keri Lestari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Ka Keat Lim
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Julia Fox-Rushby
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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17
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Scheerman JFM, Qari AH, Varenne B, Bijwaard H, Swinckels L, Giraudeau N, van Meijel B, Mariño R. A Systematic Umbrella Review of the Effects of Teledentistry on Costs and Oral-Health Outcomes. Int J Environ Res Public Health 2024; 21:407. [PMID: 38673320 PMCID: PMC11050059 DOI: 10.3390/ijerph21040407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Teledentistry offers possibilities for improving efficiency and quality of care and supporting cost-effective healthcare systems. This umbrella review aims to synthesize existing systematic reviews on teledentistry and provide a summary of evidence of its clinical- and cost-effectiveness. A comprehensive search strategy involving various teledentistry-related terms, across seven databases, was conducted. Articles published until 24 April 2023 were considered. Two researchers independently reviewed titles, abstracts and full-text articles. The quality of the included reviews was critically appraised with the AMSTAR-2 checklist. Out of 749 studies identified, 10 were included in this umbrella review. Two reviews focusing on oral-health outcomes revealed that, despite positive findings, there is not yet enough evidence for the long-term clinical effectiveness of teledentistry. Ten reviews reported on economic evaluations or costs, indicating that teledentistry is cost-saving. However, these conclusions were based on assumptions due to insufficient evidence on cost-effectiveness. The main limitation of our umbrella review was the critically low quality of the included reviews according to AMSTAR-2 criteria, with many of these reviews basing their conclusions on low-quality studies. This highlights the need for high-quality experimental studies (e.g., RCTs, factorial designs, stepped-wedge designs, SMARTs and MRTs) to assess teledentistry's clinical- and cost-effectiveness.
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Affiliation(s)
- Janneke F. M. Scheerman
- Oral Hygiene, Cluster Health, Sport and Welfare, Inholland University of Applied Sciences, 1081 LA Amsterdam, The Netherlands
- Medical Technology Research Group, Cluster Health, Sport and Welfare, Inholland University of Applied Sciences, 2015 CE Haarlem, The Netherlands
- Mental Health Nursing Research Group, Cluster Health, Sport and Welfare, Inholland University of Applied Sciences, 2015 CE Haarlem, The Netherlands
| | - Alaa H. Qari
- College of Dental Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
| | - Benoit Varenne
- Oral Health Programme, Department of Noncommunicable Diseases, Rehabilitation and Disability (NCD), World Health Organization, 1202 Geneva, Switzerland;
| | - Harmen Bijwaard
- Medical Technology Research Group, Cluster Health, Sport and Welfare, Inholland University of Applied Sciences, 2015 CE Haarlem, The Netherlands
- Centre for Safety, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
| | - Laura Swinckels
- Oral Hygiene, Cluster Health, Sport and Welfare, Inholland University of Applied Sciences, 1081 LA Amsterdam, The Netherlands
- Medical Technology Research Group, Cluster Health, Sport and Welfare, Inholland University of Applied Sciences, 2015 CE Haarlem, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, 1081 LA Amsterdam, The Netherlands
| | | | - Berno van Meijel
- Mental Health Nursing Research Group, Cluster Health, Sport and Welfare, Inholland University of Applied Sciences, 2015 CE Haarlem, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centre (UMC) and Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, 2552 DH The Hague, The Netherlands
| | - Rodrigo Mariño
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 01145, Chile
- Melbourne Dental School, University of Melbourne, Melbourne, VIC 3052, Australia
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Harris E. Remote Hypertension Monitoring Improved Medication Use, Raised Costs. JAMA 2023; 330:2146. [PMID: 37991792 DOI: 10.1001/jama.2023.22936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
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Chen K, Zhang C, Jackson HB. Relative billing complexity of in-person versus telehealth outpatient encounters. J Eval Clin Pract 2023; 29:887-892. [PMID: 37515392 DOI: 10.1111/jep.13905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
RATIONALE Video visits became more widely available during the coronavirus disease (COVID-19) pandemic. However, the ongoing role and value of video visits in care delivery and how these may have changed over time are not well understood. AIMS AND OBJECTIVES Compare the relative complexity of in-person versus video visits during the COVID-19 pandemic and describe the complexity of video visits over time. METHODS We used billing data for in-person and video revisits from non-behavioural health specialities with the most video visit utilisation (≥50th percentile) at a large, urban, public healthcare system from 1 January 2021 to 31 March 2022. We used current procedural terminology (CPT) codes as a proxy for information gathering and decision-making complexity and time spent on an encounter. We compared the distribution of CPT codes 99211-99215 between in-person and video visits using Fisher's exact tests. We used Spearman correlation to test for trends between proportions of CPT codes over time for video visits. RESULTS Ten specialities (adult primary care, paediatrics, adult dermatology, bariatric surgery, paediatric endocrinology, obstetrics and gynaecologist, adult haematology/oncology, paediatric allergy/immunology, paediatric gastroenterology, and paediatric pulmonology) met inclusion criteria. For each speciality, proportions of each CPT code for in-person visits and for video visits varied significantly, and patterns of variation differed by speciality. For example, in adult primary care, video visits had smaller proportions of moderate/high complexity visits (99214 and 99215) and greater proportions of lower complexity visits (99211-99213) compared with in-person visits (p < 0.001), but in paediatric endocrinology, the opposite was seen (p < 0.001). Trends in CPT codes over time for video visits in each speciality were also mixed. CONCLUSION In-person and video visits had differing proportions of complexity codes (typically skewing towards lower complexity for video visits). The complexity of video visits changed over time in many specialities. Observed patterns for both phenomena varied by speciality.
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Affiliation(s)
- Kevin Chen
- Office of Ambulatory Care and Population Health, New York City Health+Hospitals, New York, New York, USA
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York, USA
| | - Christine Zhang
- Office of Ambulatory Care and Population Health, New York City Health+Hospitals, New York, New York, USA
| | - Hannah B Jackson
- Office of Ambulatory Care and Population Health, New York City Health+Hospitals, New York, New York, USA
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York, USA
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Holmgren AJ, Byron ME, Grouse CK, Adler-Milstein J. Association Between Billing Patient Portal Messages as e-Visits and Patient Messaging Volume. JAMA 2023; 329:339-342. [PMID: 36607621 PMCID: PMC10408262 DOI: 10.1001/jama.2022.24710] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
This study evaluates the adoption of clinician billing for patient portal messages as e-visits, prompted by significant increases in patient messaging after the onset of the COVID-19 pandemic.
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Affiliation(s)
- A. Jay Holmgren
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco
| | - Maria E. Byron
- Department of Medicine, University of California, San Francisco
| | - Carrie K. Grouse
- Department of Neurology, University of California, San Francisco
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco
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Affiliation(s)
- Ateev Mehrotra
- From Harvard Medical School and Beth Israel Deaconess Medical Center - both in Boston (A.M.); and the RAND Corporation, Arlington, VA (L.U.-P.)
| | - Lori Uscher-Pines
- From Harvard Medical School and Beth Israel Deaconess Medical Center - both in Boston (A.M.); and the RAND Corporation, Arlington, VA (L.U.-P.)
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22
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Wilson E, Gannon H, Chimhini G, Fitzgerald F, Khan N, Lorencatto F, Kesler E, Nkhoma D, Chiyaka T, Haghparast-Bidgoli H, Lakhanpaul M, Cortina Borja M, Stevenson AG, Crehan C, Sassoon Y, Hull-Bailey T, Curtis K, Chiume M, Chimhuya S, Heys M. Protocol for an intervention development and pilot implementation evaluation study of an e-health solution to improve newborn care quality and survival in two low-resource settings, Malawi and Zimbabwe: Neotree. BMJ Open 2022; 12:e056605. [PMID: 35790332 PMCID: PMC9258512 DOI: 10.1136/bmjopen-2021-056605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Every year 2.4 million deaths occur worldwide in babies younger than 28 days. Approximately 70% of these deaths occur in low-resource settings because of failure to implement evidence-based interventions. Digital health technologies may offer an implementation solution. Since 2014, we have worked in Bangladesh, Malawi, Zimbabwe and the UK to develop and pilot Neotree: an android app with accompanying data visualisation, linkage and export. Its low-cost hardware and state-of-the-art software are used to improve bedside postnatal care and to provide insights into population health trends, to impact wider policy and practice. METHODS AND ANALYSIS This is a mixed methods (1) intervention codevelopment and optimisation and (2) pilot implementation evaluation (including economic evaluation) study. Neotree will be implemented in two hospitals in Zimbabwe, and one in Malawi. Over the 2-year study period clinical and demographic newborn data will be collected via Neotree, in addition to behavioural science informed qualitative and quantitative implementation evaluation and measures of cost, newborn care quality and usability. Neotree clinical decision support algorithms will be optimised according to best available evidence and clinical validation studies. ETHICS AND DISSEMINATION This is a Wellcome Trust funded project (215742_Z_19_Z). Research ethics approvals have been obtained: Malawi College of Medicine Research and Ethics Committee (P.01/20/2909; P.02/19/2613); UCL (17123/001, 6681/001, 5019/004); Medical Research Council Zimbabwe (MRCZ/A/2570), BRTI and JREC institutional review boards (AP155/2020; JREC/327/19), Sally Mugabe Hospital Ethics Committee (071119/64; 250418/48). Results will be disseminated via academic publications and public and policy engagement activities. In this study, the care for an estimated 15 000 babies across three sites will be impacted. TRIAL REGISTRATION NUMBER NCT0512707; Pre-results.
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Affiliation(s)
- Emma Wilson
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hannah Gannon
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gwendoline Chimhini
- Unit of Child and Adolescent Health, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Felicity Fitzgerald
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, London, UK
| | - Nushrat Khan
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Erin Kesler
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Deliwe Nkhoma
- Parent and Child Health Initiative Trust, Lilongwe, Central Region, Malawi
| | - Tarisai Chiyaka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Monica Lakhanpaul
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Mario Cortina Borja
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Caroline Crehan
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Tim Hull-Bailey
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Msandeni Chiume
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Simbarashe Chimhuya
- Unit of Child and Adolescent Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Michelle Heys
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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23
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Larkin HD. Resolving Payment Issues Is Essential to Realize Telehealth's Promise. JAMA 2022; 327:1856-1858. [PMID: 35476119 DOI: 10.1001/jama.2022.7460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Nathania J, Woo BFY, Cher BP, Toh KY, Chia WYA, Lim YW, Vrijhoef HJM, Lim TW. Patient perspectives of the Self-management and Educational Technology tool for Atrial Fibrillation (SETAF): A mixed-methods study in Singapore. PLoS One 2022; 17:e0262033. [PMID: 35061749 PMCID: PMC8782297 DOI: 10.1371/journal.pone.0262033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrythmia and is associated with costly morbidity such as stroke and heart failure. Mobile health (mHealth) has potential to help bridge the gaps of traditional healthcare models that may be poorly suited to the sporadic nature of AF. The Self-management and Educational technology support Tool for AF patients (SETAF) was designed based on the preferences and needs of AF patients but more study is required to assess the acceptance of this novel tool. OBJECTIVE Explore the usability and acceptance of SETAF among AF patients in Singapore. METHODS A mixed methods study was conducted with AF patients who were purposively sampled from an outpatient cardiology clinic in Singapore. After 6 weeks of using SETAF, semi-structured interviews were performed, and data were analyzed inductively following a thematic analysis approach. Results from a short 4-item survey and application usage data were also analyzed descriptively. Both qualitative and quantitative results were organized and presented following the Technology Acceptance Model (TAM) framework. RESULTS A total of 37 patients participated in the study and 19 were interviewed. Participants perceived SETAF as useful for improving AF knowledge, self-management and access to healthcare providers and was easy to use due to the guided tutorial and user-friendly interface. They also identified the need for better personalization of content, psychosocial support features and reduction of language barriers. Application usage data revealed preference for AF related content and decreased interaction with the motivational message component of SETAF over time. Overall, most of the participants would continue using SETAF and were willing to pay for it. CONCLUSIONS AF patients in Singapore found SETAF useful and acceptable as a tool for AF management. The insights from this study not only support the potential of mHealth but may also inform the design and implementation of future mHealth tools for AF patients.
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Affiliation(s)
- Jennifer Nathania
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Brigitte Fong Yeong Woo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Boon Piang Cher
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Kai Yee Toh
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Wei-Yan Aloysius Chia
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Yee Wei Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hubertus J. M. Vrijhoef
- Panaxea, Amsterdam, The Netherlands
- Department of Patient and Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Toon Wei Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Hospital, Singapore, Singapore
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Van Citters AD, Dieni O, Scalia P, Dowd C, Sabadosa KA, Fliege JD, Jain M, Miller RW, Ren CL. Barriers and facilitators to implementing telehealth services during the COVID-19 pandemic: A qualitative analysis of interviews with cystic fibrosis care team members. J Cyst Fibros 2021; 20 Suppl 3:23-28. [PMID: 34930537 PMCID: PMC8683122 DOI: 10.1016/j.jcf.2021.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/19/2022]
Abstract
Background The COVID-19 pandemic forced cystic fibrosis (CF) care programs to rapidly shift from in-person care delivery to telehealth. Our objective was to provide a qualitative exploration of facilitators and barriers to: 1) implementing high-quality telehealth and 2) navigating reimbursement for telehealth services. Methods We used data from the 2020 State of Care CF Program Survey (n=286 U.S. care programs) administered in August-September to identify two cohorts of programs, with variation in telehealth quality (n=12 programs) and reimbursement (n=8 programs). We conducted focus groups and semi-structured interviews with CF program directors and coordinators in December 2020, approximately 9 months from onset of the pandemic. We used the Consolidated Framework for Implementation Research to identify facilitators and barriers of implementation, and inductive thematic analysis to identify facilitators and barriers of reimbursement. Results Factors differentiating programs with greater and lower perceived telehealth quality included telehealth characteristics (perceived advantage over in-person care, cost, platform quality); external influences (needs and resources of those served by the CF program), characteristics of the CF program (compatibility with workflows, relative priority, available resources); characteristics of team members (individual stage of change), and processes for implementation (engaging patients and teams). Reimbursement barriers included documentation to optimize billing; reimbursement of multi-disciplinary team members, remote monitoring, and telephone-only telehealth; and lower volume of patients. Conclusions A number of factors are associated with successful implementation and reimbursement of telehealth. Future efforts should provide guidance and incentives that support telehealth delivery and infrastructure, share best practices across CF programs, and remove barriers.
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Affiliation(s)
- Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, One Medical Center Drive, Lebanon, NH, 03766, USA.
| | - Olivia Dieni
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, One Medical Center Drive, Lebanon, NH, 03766, USA
| | - Christopher Dowd
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 USA
| | - Kathryn A Sabadosa
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 USA
| | - Jill D Fliege
- Adult Cystic Fibrosis Nurse Practitioner / Program Coordinator; Pulmonary, Critical Care, Sleep and Allergy Medicine, 985990 Nebraska Medicine, Omaha, NE, 69198-5990, USA
| | - Manu Jain
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Robert W Miller
- Lehigh Valley Reilly Children's Hospital Cystic Fibrosis Center, 1210 Cedar Crest Blvd, Suite 2700, Allentown, PA, 18103, USA
| | - Clement L Ren
- Children's Hospital of Philadelphia, Division of Pulmonary and Sleep Medicine, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Rozga M, Handu D, Kelley K, Jimenez EY, Martin H, Schofield M, Steiber A. Telehealth During the COVID-19 Pandemic: A Cross-Sectional Survey of Registered Dietitian Nutritionists. J Acad Nutr Diet 2021; 121:2524-2535. [PMID: 33612436 PMCID: PMC7834621 DOI: 10.1016/j.jand.2021.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 01/12/2023]
Abstract
During the current coronavirus disease 2019 (COVID-19) pandemic, health care practices have shifted to minimize virus transmission, with unprecedented expansion of telehealth. This study describes self-reported changes in registered dietitian nutritionist (RDN) practice related to delivery of nutrition care via telehealth shortly after the onset of the COVID-19 pandemic in the United States. This cross-sectional, anonymous online survey was administered from mid-April to mid-May 2020 to RDNs in the United States providing face-to-face nutrition care prior to the COVID-19 pandemic. This survey included 54 questions about practitioner demographics and experience and current practices providing nutrition care via telehealth, including billing procedures, and was completed by 2016 RDNs with a median (interquartile range) of 15 (6-27) years of experience in dietetics practice. Although 37% of respondents reported that they provided nutrition care via telehealth prior to the COVID-19 pandemic, this proportion was 78% at the time of the survey. Respondents reported spending a median (interquartile range) of 30 (20-45) minutes in direct contact with the individual/group per telehealth session. The most frequently reported barriers to delivering nutrition care via telehealth were lack of client interest (29%) and Internet access (26%) and inability to conduct or evaluate typical nutrition assessment or monitoring/evaluation activities (28%). Frequently reported benefits included promoting compliance with social distancing (66%) and scheduling flexibility (50%). About half of RDNs or their employers sometimes or always bill for telehealth services, and of those, 61% are sometimes or always reimbursed. Based on RDN needs, the Academy of Nutrition and Dietetics continues to advocate and provide resources for providing effective telehealth and receiving reimbursement via appropriate coding and billing. Moving forward, it will be important for RDNs to participate fully in health care delivered by telehealth and telehealth research both during and after the COVID-19 public health emergency.
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Affiliation(s)
- Mary Rozga
- Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL.
| | - Deepa Handu
- Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL
| | - Kathryn Kelley
- Academy of Nutrition and Dietetics Nutrition Research Network, Chicago, IL
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Chicago, IL
| | - Hannah Martin
- Legislative and Government Affairs, Academy of Nutrition and Dietetics, Washington, DC
| | - Marsha Schofield
- Governance and Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago, IL
| | - Alison Steiber
- Academy of Nutrition and Dietetics Nutrition Research Network, Chicago, IL
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Romijn G, Batelaan N, Koning J, van Balkom A, de Leeuw A, Benning F, Hakkaart van Roijen L, Riper H. Acceptability, effectiveness and cost-effectiveness of blended cognitive-behavioural therapy (bCBT) versus face-to-face CBT (ftfCBT) for anxiety disorders in specialised mental health care: A 15-week randomised controlled trial with 1-year follow-up. PLoS One 2021; 16:e0259493. [PMID: 34767575 PMCID: PMC8589191 DOI: 10.1371/journal.pone.0259493] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and cause substantial economic burden. Blended cognitive-behavioural therapy (bCBT), which integrates Internet-based CBT and face-to-face CBT (ftfCBT), is an attractive and potentially cost-saving treatment alternative to conventional CBT for patients with anxiety disorders in specialised mental health care. However, little is known about the effectiveness of bCBT in routine care. We examined the acceptability, effectiveness and cost-effectiveness of bCBT versus ftfCBT in outpatient specialised care to patients with panic disorder, social anxiety disorder and generalised anxiety disorder. METHODS AND FINDINGS Patients with anxiety disorders were randomised to bCBT (n = 52) or ftfCBT (n = 62). Acceptability of bCBT and ftfCBT were evaluated by assessing treatment preference, adherence, satisfaction and therapeutic alliance. Costs and effects were assessed at post-treatment and one-year follow-up. Primary outcome measure was the Beck Anxiety Inventory (BAI). Secondary outcomes were depressive symptoms, general psychopathology, work and social adjustment, quality of life and mastery. Incremental cost-effectiveness ratios (ICERs) were computed from societal and healthcare perspectives by calculating the incremental costs per incremental quality-adjusted life year (QALY). No significant differences between bCBT and ftfCBT were found on acceptability or effectiveness measures at post-treatment (Cohen's d between-group effect size on BAI = 0.15, 95% CI -0.30 to 0.60) or at one-year follow-up (d = -0.38, 95% CI -0.84 to 0.09). The modelled point estimates of societal costs (bCBT €10945, ftfCBT €10937) were higher and modelled point estimates of direct medical costs (bCBT €3748, ftfCBT €3841) were lower in bCBT. The acceptability curves showed that bCBT was expected to be a cost-effective intervention. Results should be carefully interpreted due to the small sample size. CONCLUSIONS bCBT appears an acceptable, clinically effective and potentially cost-saving alternative option for treating patients with anxiety disorders. Trials with larger samples are needed to further investigate cost-effectiveness. TRIAL REGISTRATION Netherlands Trial Register: NTR4912.
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Affiliation(s)
- Geke Romijn
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Specialised Mental Health Institution, GGz Breburg, Tilburg, the Netherlands
- Altrecht Academic Anxiety Centre, Utrecht, Netherlands
| | - Neeltje Batelaan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Koning
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Institute for Psychiatry, Vincent van Gogh, Venray, The Netherlands
| | - Anton van Balkom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Aart de Leeuw
- Altrecht Academic Anxiety Centre, Utrecht, Netherlands
| | - Friederike Benning
- Department of Health Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - Leona Hakkaart van Roijen
- Department of Health Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - Heleen Riper
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Centre for Telepsychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
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Jourdain P, Artigou JY, Hryschyschyn N, Berthelot E, Bailly MT, Dinh A, Assayag P. [Telemedicine from experimentation (ETAPES) to COVIDOM… a new era ?]. Ann Cardiol Angeiol (Paris) 2021; 70:317-321. [PMID: 34627623 DOI: 10.1016/j.ancard.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
Telemedicine has been recognized since 2010 as a constitutive element of care, however, it was not until 2016 that the first national experiments were able to be launched with the aim of validating a framework allowing a possible rapid passage in the common right. These experiments, which are due to end in December 2021, have succeeded in involving more than 100,000 patients, mainly suffering from cardiac pathologies. The arrival of COVID-19 has made it possible to measure the usefulness of practices at a distance both from teleconsultation and telemonitoring, with the appearance of organizational and technical innovations that must now be maintained and developed in order to integrate the telemedicine of tomorrow into our actual medicine.
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Affiliation(s)
- Patrick Jourdain
- Service de cardiologie, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270LE KREMLIN-BICETRE, France; INSERM U 1018, centre de recherche en épidemiologie et santé des populations, 94807VILLEJUIF, France; INSERM U999, pulmonary hypertension : pathophysiology and novel therapies, Hôpital de Bicêtre et Université Paris XI Paris-Saclay, 94270LE KREMLIN-BICETRE, France.
| | - Jean-Yves Artigou
- Service de cardiologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, BOBIGNY, France
| | - Natalya Hryschyschyn
- Service de cardiologie, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270LE KREMLIN-BICETRE, France
| | - Emmanuelle Berthelot
- Service de cardiologie, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270LE KREMLIN-BICETRE, France
| | - Minh Tam Bailly
- Service de cardiologie, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270LE KREMLIN-BICETRE, France
| | - Aurelien Dinh
- Service des maladies infectieuses, CHU Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, 92380GARCHES, France; Service de Médecine Interne, Hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris, 92100BOULOGNE-BILLANCOURT, France
| | - Patrick Assayag
- Service de cardiologie, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270LE KREMLIN-BICETRE, France
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Bhardwaj V, Spaulding EM, Marvel FA, LaFave S, Yu J, Mota D, Lorigiano TJ, Huynh PP, Shan R, Yesantharao PS, Lee MA, Yang WE, Demo R, Ding J, Wang J, Xun H, Shah L, Weng D, Wongvibulsin S, Carter J, Sheidy J, McLin R, Flowers J, Majmudar M, Elgin E, Vilarino V, Lumelsky D, Leung C, Allen JK, Martin SS, Padula WV. Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery. Med Care 2021; 59:1023-1030. [PMID: 34534188 PMCID: PMC8516712 DOI: 10.1097/mlr.0000000000001636] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The "Corrie" DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone. METHODS A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty. RESULTS The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7% of simulations in the probabilistic analysis. Based on the assumption that the DHI costs $2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone. CONCLUSIONS Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs.
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Affiliation(s)
- Vinayak Bhardwaj
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Erin M. Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Francoise A. Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Sarah LaFave
- Johns Hopkins University School of Nursing, Baltimore, MD, US
| | - Jeffrey Yu
- Johns Hopkins Health System, Baltimore, MD, US
- Dept. of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, US
| | - Daniel Mota
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Dimock Center, Baltimore, MD, US
| | | | - Pauline P. Huynh
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Rongzi Shan
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Pooja S. Yesantharao
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - William E. Yang
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - Jie Ding
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Jane Wang
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Helen Xun
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Lochan Shah
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Daniel Weng
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Shannon Wongvibulsin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | | | | | | | | | - Maulik Majmudar
- Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | | | - Valerie Vilarino
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD, US
| | - David Lumelsky
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD, US
| | | | - Jerilyn K. Allen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Johns Hopkins University School of Nursing, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Seth S. Martin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - William V. Padula
- Dept. of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, US
- Leonard D. Schaeffer Center for Health Economics & Policy, University of Southern California, Los Angeles, CA
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Abstract
This cross-sectional study evaluates how the growth of virtual care has impacted health care utilization in an integrated delivery network.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Zhiyu Yan
- Department of Neurology, Boston, Massachusetts
| | - Lee H. Schwamm
- Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Boston, Massachusetts
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Affiliation(s)
- Julia Adler-Milstein
- From the Center for Clinical Informatics and Improvement Research, University of California, San Francisco (J.A.M.), and Harvard Medical School, Boston (A.M.)
| | - Ateev Mehrotra
- From the Center for Clinical Informatics and Improvement Research, University of California, San Francisco (J.A.M.), and Harvard Medical School, Boston (A.M.)
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Flemming J, Armijo-Olivo S, Dennett L, Lapointe P, Robertson D, Wang J, Ohinmaa A. Enhanced Home Care Interventions for Community Residing Adults Compared With Usual Care on Health and Cost-effectiveness Outcomes: A Systematic Review. Am J Phys Med Rehabil 2021; 100:906-917. [PMID: 34415887 DOI: 10.1097/phm.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The need for home care services is expanding around the world with increased attention to the resources required to produce them. To assist decision making, there is a need to assess the cost-effectiveness of alternative programs within home care. Electronic searches were performed in five databases (before February 2020) identifying 3292 potentially relevant studies that assessed new or enhanced home care interventions compared with usual care for adults with an accompanying economic evaluation. From these, 133 articles were selected for full-text screening; 17 met the inclusion criteria and were analyzed. Six main areas of research were identified including the following: alternative nursing care (n = 4), interdisciplinary care coordination (n = 4), fall prevention (n = 4), telemedicine/remote monitoring (n = 2), restorative/reablement care (n = 2), and one multifactorial undernutrition intervention study. Risk of bias was found to be high/weak (n = 7) or have some concerns/moderate (n = 6) rating, in addition to inconsistent reporting of important information required for economic evaluations. Both health and cost outcomes had mixed results. Cost-effective interventions were found in two areas including alternative nursing care and reablement/restorative care. Clinicians and decision makers are encouraged to carefully evaluate the quality of the studies because of issues with risk of bias and incomplete reporting of economic outcomes.
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Affiliation(s)
- Julie Flemming
- From the University of Alberta, School of Public Health, Edmonton, Alberta, Canada (JF, SA-O, JW, AO); Alberta Health Services, Edmonton, Alberta, Canada (JF, PL); University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Alberta, Canada (SA-O); University of Applied Sciences, Faculty of Business and Social Sciences, Osnabrück, Germany (SA-O); and University of Alberta, Scott Health Sciences Library, Edmonton, Alberta, Canada (LD)
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Abstract
Medicare initiatives have been instrumental in improving care delivery and payment as exemplified by its role in broadly expanding the use of telehealth during the COVID-19 pandemic. Medicare innovations have been adopted or adapted in Medicaid and by private payers, while Medicare Advantage plans successfully compete with traditional Medicare only because their payment rates are tied by regulation to those in the traditional Medicare program. However, Medicare has not succeeded in implementing new, value-based payment approaches that also would serve as models for other payers, nor has Medicare succeeded in improving quality by relying on public reporting of measured performance. It is increasingly clear that burdensome attention to measurement and reporting distracts from what could be successful efforts to actually improve care through quality improvement programs, with Medicare leading in partnership with providers, other payers, and patients. Although Congress is unlikely to adopt President Biden's proposals to decrease the eligibility age for Medicare or to adopt a public option based on Medicare prices and payment methods in the marketplaces, the Biden administration has an opportunity to provide overdue, strategic direction to the pursuit of value-based payments and to replace failed pay-for-performance with provider-managed projects to improve quality and reduce health disparities.
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McLachlan A, Aldridge C, Morgan M, Lund M, Gabriel R, Malez V. An NP-led pilot telehealth programme to facilitate guideline-directed medical therapy for heart failure with reduced ejection fraction during the COVID-19 pandemic. N Z Med J 2021; 134:77-88. [PMID: 34239147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIMS Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes. While several medications are beneficial, achieving optimal guideline-directed medical therapy (GDMT) is challenging. COVID-19 created a need to explore new ways to deliver care. METHODS Fifty consecutive patients were taught to identify fluid congestion and monitor their vital signs using BP monitors and electronic scales with NP-led telephone support. Quantitative data were collected and a patient experience interview was performed. RESULTS The majority (76%) of the cohort (male, 76%; Māori/Pacific, 58%) had a new diagnosis of HFrEF, with 90% having severe left ventricular (LV) dysfunction. There were 216 contacts (129 (60%) by telephone), which eliminated travelling, (time saved, 2.12 hours per patient), petrol costs ($58.17 per patient), traffic pollution (607 Kg of CO2) and time off work. Most (75%) received contact within two weeks and 75% were optimally titrated within two months. Improvements in systolic BP (SBP) (124mmHg to 116mmHg), pulse (78 bpm to 70 bpm) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (292 to 65) were identified. Of the 43 patients who had a follow-up transthoracic echocardiogram (TTE), 33 (77%) showed important improvement in left ventricular ejection fraction (LVEF). CONCLUSIONS Patients found the process acceptable and experienced rapid titration with less need for clinic review with titration rates comparable with most real-world reports.
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Wilson G, Currie O, Bidwell S, Saeed B, Dowell A, Halim AA, Toop L, Richardson A, Savage R, Hudson B. Empty waiting rooms: the New Zealand general practice experience with telehealth during the COVID-19 pandemic. N Z Med J 2021; 134:89-101. [PMID: 34239148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM The primary care response to the coronavirus disease 2019 (COVID-19) pandemic in early 2020 required significant changes to the delivery of healthcare by general practices. This study explores the experiences of New Zealand general practice teams in their use of telehealth during the early stages of the COVID-19 pandemic in New Zealand. METHOD We qualitatively analysed a subtheme on telehealth of the General Practice Pandemic Experience New Zealand (GPPENZ) study, where general practice team members across the country were invited to participate in five surveys between 8 May 2020 to 27 August 2020. RESULTS 164 participants enrolled in the study during survey one, with 78 (48%) completing all surveys. Five telehealth themes were identified: benefits, limitations, paying for consults, changes over time and plans for future use. Benefits included rapid triage, convenience and efficiency, and limitations included financial and technical barriers for practices and patients and concerns about clinical risk. Respondents rapidly returned to in-person consultations and wanted clarification of conditions suited to telehealth, better infrastructure and funding. CONCLUSION To equitably sustain telehealth use, the following are required: adequate funding, training, processes communicated to patients, improved patient access to technology and technological literacy, virtual physical examination methods and integration with existing primary health care services.
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Affiliation(s)
- Geraldine Wilson
- General Practitioner, Senior Research Fellow, Department of General Practice, University of Otago, Christchurch
| | - Olivia Currie
- General Practitioner, Senior Research Fellow, Department of General Practice, University of Otago, Christchurch
| | - Susan Bidwell
- Senior Research Fellow, Department of General Practice, University of Otago, Christchurch
| | - Baraah Saeed
- Medical Student, University of Otago, Christchurch
| | - Anthony Dowell
- Professor of Primary Health Care and General Practice, University of Otago, Wellington
| | | | - Les Toop
- Professor of General Practice, Department of General Practice, University of Otago, Christchurch
| | | | - Ruth Savage
- Senior Lecturer, Department of General Practice, University of Otago, Christchurch
| | - Ben Hudson
- Senior Lecturer Department of General Practice, University of Otago, Christchurch
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Werfel KL, Grey B, Johnson M, Brooks M, Cooper E, Reynolds G, Deutchki E, Vachio M, Lund EA. Transitioning Speech-Language Assessment to a Virtual Environment: Lessons Learned From the ELLA Study. Lang Speech Hear Serv Sch 2021; 52:769-775. [PMID: 34153204 PMCID: PMC8711709 DOI: 10.1044/2021_lshss-20-00149] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022] Open
Abstract
Purpose The COVID-19 pandemic has necessitated a quick shift to virtual speech-language services; however, only a small percentage of speech-language pathologists (SLPs) had previously engaged in telepractice. The purpose of this clinical tutorial is (a) to describe how the Early Language and Literacy Acquisition in Children with Hearing Loss study, a longitudinal study involving speech-language assessment with children with and without hearing loss, transitioned from in-person to virtual assessment and (b) to provide tips for optimizing virtual assessment procedures. Method We provide an overview of our decision making during the transition to virtual assessment. Additionally, we report on a pilot study that calculated test-retest reliability from in-person to virtual assessment for a subset of our preschool-age participants. Results Our pilot study revealed that most speech-language measures had high or adequate test-retest reliability when administered in a virtual environment. When low reliability occurred, generally the measures were timed. Conclusions Speech-language assessment can be conducted successfully in a virtual environment for preschool children with hearing loss. We provide suggestions for clinicians to consider when preparing for virtual assessment sessions. Supplemental Material https://doi.org/10.23641/asha.14787834.
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Affiliation(s)
- Krystal L. Werfel
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Brittany Grey
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Michelle Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Marren Brooks
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Ellie Cooper
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Gabriella Reynolds
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Elizabeth Deutchki
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Morgan Vachio
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Emily A. Lund
- Davies School of Communication Sciences & Disorders, Texas Christian University, Fort Worth
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Palmer KR, Tanner M, Davies-Tuck M, Rindt A, Papacostas K, Giles ML, Brown K, Diamandis H, Fradkin R, Stewart AE, Rolnik DL, Stripp A, Wallace EM, Mol BW, Hodges RJ. Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis. Lancet 2021; 398:41-52. [PMID: 34217399 PMCID: PMC8248925 DOI: 10.1016/s0140-6736(21)00668-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care. METHODS We analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation). FINDINGS Between Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0·72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0·50 for high-risk care models), number of stillbirths (1% vs 1%, p=0·79; 2% vs 2%, p=0·70), or pregnancies complicated by pre-eclampsia (3% vs 3%, p=0·70; 9% vs 7%, p=0·15), or gestational diabetes (22% vs 22%, p=0·89; 30% vs 26%, p=0·06). Interrupted time-series analysis showed a significant reduction in preterm birth among women in high-risk models (-0·68% change in incidence per week [95% CI -1·37 to -0·002]; p=0·049), but no significant differences were identified in other outcome measures for low-risk or high-risk care models after telehealth integration compared with conventional care. INTERPRETATION Telehealth integrated antenatal care enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. This care model can help to minimise in-person interactions during the COVID-19 pandemic, but should also be considered in post-pandemic health-care models. FUNDING None.
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Affiliation(s)
- Kirsten R Palmer
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - Michael Tanner
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | | | - Andrea Rindt
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Kerrie Papacostas
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Michelle L Giles
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Kate Brown
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Helen Diamandis
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Rebecca Fradkin
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Alice E Stewart
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Daniel L Rolnik
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Andrew Stripp
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia; Monash Health, Clayton, VIC, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Safer Care Victoria, Melbourne, VIC, Australia
| | - Ben W Mol
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Ryan J Hodges
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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Abstract
The COVID-19 pandemic has accelerated the adoption and acceptance of remote monitoring and other digital approaches to cardiovascular disease management across the world. We argue that considerable additional effort is required to ensure appropriate multi-stakeholder involvement in the development, evaluation and best use of an ever-increasing number of digital technologies.
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Affiliation(s)
- Martin R Cowie
- National Heart & Lung Institute, Imperial College London, London, UK.
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore
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Abstract
Teledermatology, the form of telemedicine directed toward dermatology patients, is one of the earliest technological innovations that advanced remote medical care. Developed in 1995, teledermatology was established with the mission of increasing healthcare access among patients in rural geographic locations who had limited access to specialist care.1.
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Affiliation(s)
- Keizra Mecklai
- From Harvard Medical School (K.M., N.S., D.B.K.), Harvard Business School (K.M., N.S., A.D.S.), the Harvard-MIT Center for Regulatory Science (A.D.S.), and the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center (D.B.K.) - all in Boston; and the Health Innovation Hub, German Federal Ministry of Health, Berlin (A.D.S.)
| | - Nicholas Smith
- From Harvard Medical School (K.M., N.S., D.B.K.), Harvard Business School (K.M., N.S., A.D.S.), the Harvard-MIT Center for Regulatory Science (A.D.S.), and the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center (D.B.K.) - all in Boston; and the Health Innovation Hub, German Federal Ministry of Health, Berlin (A.D.S.)
| | - Ariel D Stern
- From Harvard Medical School (K.M., N.S., D.B.K.), Harvard Business School (K.M., N.S., A.D.S.), the Harvard-MIT Center for Regulatory Science (A.D.S.), and the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center (D.B.K.) - all in Boston; and the Health Innovation Hub, German Federal Ministry of Health, Berlin (A.D.S.)
| | - Daniel B Kramer
- From Harvard Medical School (K.M., N.S., D.B.K.), Harvard Business School (K.M., N.S., A.D.S.), the Harvard-MIT Center for Regulatory Science (A.D.S.), and the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center (D.B.K.) - all in Boston; and the Health Innovation Hub, German Federal Ministry of Health, Berlin (A.D.S.)
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Murphy EP, Fenelon C, Kennedy JF, O'Sullivan MD, Noel J, Kelly PM, Moore DP, O'Toole PJ. Establishing a Virtual Clinic for Developmental Dysplasia of the Hip: A Prospective Study. J Pediatr Orthop 2021; 41:209-215. [PMID: 33492040 DOI: 10.1097/bpo.0000000000001755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim was to describe the introduction and operation of a virtual developmental dysplasia of the hip (DDH) clinic. Our secondary objectives were to provide an overview of DDH referral reasons, treatment outcomes, and adverse events associated with it. METHODS A prospective observational study involving all patients referred to the virtual DDH clinic was conducted. The clinic consultant delivered with 2 DDH clinical nurse specialists (CNS). The outcomes following virtual review include further virtual review, CNS review, consultant review or discharge. Treatment options include surveillance, brace therapy, or surgery. Efficiency and cost analysis were assessed. RESULTS Over the 3.5-year study period, 1002 patients were reviewed, of which 743 (74.2%) were female. The median age at time of referral was 7 months, (interquartile range of 5 to 11) with a median time to treatment decision of 9 days. Median waiting times from referral to treatment decision was reduced by over 70%. There were 639 virtual reviews, 186 CNS reviews, and 144 consultant reviews. The direct discharge rate was 24%. One hundred one patients (10%) had dislocated or subluxed hips at initial visit while 26.3% had radiographically normal hips. Over the study period 704 face to face (F2F) visits were avoided. Cost reductions of €170 were achieved per patient, with €588,804 achieved in total. Eighteen parents (1.8%) opted for F2F instead of virtual review. There were no unscheduled rereferrals or recorded adverse events. CONCLUSION We report the outcomes of the first prospective virtual DDH clinic. This clinic has demonstrated efficiency and cost-effectiveness, without reported adverse outcomes to date. It is an option to provide consultant delivered DDH care, while reducing F2F consults. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Evelyn P Murphy
- Department of Trauma and Orthopaedics, Crumlin, Children's Health Ireland
| | - Christopher Fenelon
- Department of Orthopaedics, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - Jim F Kennedy
- Department of Trauma and Orthopaedics, Crumlin, Children's Health Ireland
| | | | - Jacques Noel
- Department of Trauma and Orthopaedics, Crumlin, Children's Health Ireland
| | - Paula M Kelly
- Department of Trauma and Orthopaedics, Crumlin, Children's Health Ireland
| | - David P Moore
- Department of Trauma and Orthopaedics, Crumlin, Children's Health Ireland
| | - Patrick J O'Toole
- Department of Trauma and Orthopaedics, Crumlin, Children's Health Ireland
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Jenkins JM, Halai M. CORR Synthesis: What Evidence Is Available for the Continued Use of Telemedicine in Orthopaedic Surgery in the Post-COVID-19 Era? Clin Orthop Relat Res 2021; 479:747-754. [PMID: 33724978 PMCID: PMC8083835 DOI: 10.1097/corr.0000000000001444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/14/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Joanne M Jenkins
- J. M. Jenkins, Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
- J. M. Jenkins, University of Glasgow, UK
- M. Halai, Department of Orthopaedics, University of Toronto, Canada
- M. Halai, Department of Orthopaedics, St Michael's Hospital, Toronto, Canada
| | - Mansur Halai
- J. M. Jenkins, Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
- J. M. Jenkins, University of Glasgow, UK
- M. Halai, Department of Orthopaedics, University of Toronto, Canada
- M. Halai, Department of Orthopaedics, St Michael's Hospital, Toronto, Canada
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Tice JA, Whittington MD, Campbell JD, Pearson SD. The effectiveness and value of digital health technologies as an adjunct to medication-assisted therapy for opioid use disorder. J Manag Care Spec Pharm 2021; 27:528-532. [PMID: 33769860 PMCID: PMC10390940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
DISCLOSURES: Funding for this summary was contributed by Arnold Ventures, California Health Care Foundation, The Donaghue Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from AbbVie, Aetna, America's Health Insurance Plans, Anthem, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Boehringer-Ingelheim, Cambia Health Services, CVS, Editas, Evolve Pharmacy, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, HealthFirst, Health Partners, Humana, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Pfizer, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, uniQure, and United Healthcare. Whittington, Campbell, and Pearson are employed by ICER. Tice reports contracts to his institution, University of California, San Francisco, from ICER during the conduct of this study.
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Affiliation(s)
- Jeffrey A Tice
- Division of General Internal Medicine, University of California, San Francisco
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Abstract
This study describes trends in use of in-person, telephone, and video primary care and behavioral health visits to California Federally Qualified Health Centers from 2019 to August 2020 before and during the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
| | | | - Maggie Jones
- Center for Community Health and Evaluation at Kaiser Permanente Washington Health Research Institute, Seattle
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Abstract
Anton Korinek and Joseph E Stiglitz make the case for a deliberate effort to steer technological advances in a direction that enhances the role of human workers
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Affiliation(s)
- Anton Korinek
- Department of Economics and Darden School of Business, University of Virginia, Charlottesville, VA, USA
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47
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van Herwerden MC, van Steenkiste J, El Moussaoui R, den Hollander JG, Helfrich G, J A M Verberk I. [Home telemonitoring and oxygen therapy in COVID-19 patients: safety, patient satisfaction, and cost-effectiveness]. Ned Tijdschr Geneeskd 2021; 165:D5740. [PMID: 33720552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the implementation of home telemonitoring and oxygen therapy in COVID-19 patients. Primary outcomes were safety, patient satisfaction, reduction of hospital stay, and cost-effectiveness. DESIGN Retrospective cohort study. METHOD All COVID-19 patients who were discharged with home telemonitoring and oxygen therapy between June 1st and November 1st 2020 were included. Eligible patients had a maximum oxygen requirement of 2 liters per minute during the 24 hours prior to discharge with a minimal peripheral oxygen saturation of 94%. A mobile application for telemonitoring was used, which patients or relatives had to be able to use independently. Patient demographics, clinical parameters, data on telemonitoring and readmissions were extracted from the electronic patient records. A survey for patient satisfaction and a cost-effectiveness analysis were performed. RESULTS Out of 619 admissions, 49 patients were discharged with home telemonitoring and oxygen therapy. Median duration of home oxygen therapy was 11 days with a potential reduction in hospitalization of 616 days. Six patients were readmitted and were significantly more febrile on discharge (67% versus 14%, p=0.01) and had lower oxygenation (95%, (IQR 93-96) versus 96%, (IQR 95-97), p=0.02) with similar levels of oxygen administration. Patient satisfaction was high with a mean score of 5 to 6 on a scale measuring satisfaction from 1 to 7. Estimated total cost reduction was € 146.736. CONCLUSION This study shows that home telemonitoring and oxygen administration can be safely applied in COVID-19 patients resulting in a high patient satisfaction and reduction in hospital stay and costs.
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Affiliation(s)
| | | | | | | | - Gea Helfrich
- Maasstad Ziekenhuis, afd. Longziekten, Rotterdam
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Jiang X, Yao J, You JHS. Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis. J Med Internet Res 2021; 23:e26516. [PMID: 33656440 PMCID: PMC7931824 DOI: 10.2196/26516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). OBJECTIVE We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. METHODS A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. RESULTS In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.
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Affiliation(s)
- Xinchan Jiang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Jiaqi Yao
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joyce Hoi-Sze You
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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Abstract
As the coronavirus disease 2019 (COVID-19) pandemic threatens to worsen the opioid crisis, payers must rapidly deploy policies to ensure care for individuals with opioid use disorder.
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Affiliation(s)
- Chethan Bachireddy
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, 1101 E Marshall St, Richmond, VA 23298.
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Weiner JP, Bandeian S, Hatef E, Lans D, Liu A, Lemke KW. In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e212618. [PMID: 33755167 PMCID: PMC7988360 DOI: 10.1001/jamanetworkopen.2021.2618] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE This study assesses the role of telehealth in the delivery of care at the start of the COVID-19 pandemic. OBJECTIVES To document patterns and costs of ambulatory care in the US before and during the initial stage of the pandemic and to assess how patient, practitioner, community, and COVID-19-related factors are associated with telehealth adoption. DESIGN, SETTING, AND PARTICIPANTS This is a cohort study of working-age persons continuously enrolled in private health plans from March 2019 through June 2020. The comparison periods were March to June in 2019 and 2020. Claims data files were provided by Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association. Data analysis was performed from June to October 2020. MAIN OUTCOMES AND MEASURES Ambulatory encounters (in-person and telehealth) and allowed charges, stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee's zip code. RESULTS A total of 36 568 010 individuals (mean [SD] age, 35.71 [18.77] years; 18 466 557 female individuals [50.5%]) were included in the analysis. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee) from 2019 to 2020. During 2020, telehealth visits (0.32 visit per person) accounted for 23.6% of all interactions compared with 0.3% of contacts in 2019. When these virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than that in 2019 (1.34 vs 1.64 visits per person). Behavioral health encounters were far more likely than medical contacts to take place virtually (46.1% vs 22.1%). COVID-19 prevalence in an area was associated with higher use of telehealth; patients from areas within the top quintile of COVID-19 prevalence during the week of their encounter were 1.34 times more likely to have a telehealth visit compared with those in the lowest quintile (the reference category). Persons living in areas with limited social resources were less likely to use telehealth (most vs least socially advantaged neighborhoods, 27.4% vs 19.9% usage rates). Per enrollee medical care costs decreased by 15% between 2019 and 2020 (from $358.32 to $306.04 per person per month). During 2020, those with 1 or more COVID-19-related service (1 470 721 members) had more than 3 times the medical costs ($1701 vs $544 per member per month) than those without COVID-19-related services. Persons with 1 or more telehealth visits in 2020 had considerably higher costs than persons having only in-person ambulatory contacts ($2214.10 vs $1337.78 for the COVID-19-related subgroup and $735.87 vs $456.41 for the non-COVID-19 subgroup). CONCLUSIONS AND RELEVANCE This study of a large cohort of patients enrolled in US health plans documented patterns of care at the onset of COVID-19. The findings are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the pandemic and afterward.
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Affiliation(s)
- Jonathan P. Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen Bandeian
- Blue Health Intelligence, LLC, an independent licensee of the Blue Cross and Blue Shield Association, Chicago, Illinois
| | - Elham Hatef
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel Lans
- Blue Health Intelligence, LLC, an independent licensee of the Blue Cross and Blue Shield Association, Chicago, Illinois
| | - Angela Liu
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Klaus W. Lemke
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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