A Statewide Child Telepsychiatry Consult System Yields Desired Health System Changes and Savings

Hilt, Robert J.; Barclay, Rebecca P.; Bush, James; Stout, Brenda; Anderson, Nichole; Wignall, Julia

doi:10.1089/tmj.2014.0161

Cited by 39 publications

(20 citation statements)

References 18 publications

(16 reference statements)

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“…Live telemedicine involves real-time, two-way transmission between a patient and provider and is most commonly used for ambulatory subspecialty consultations. Several studies have demonstrated that this type of care results in high-quality care, with high satisfaction rates reported by providers, patients, and caregivers (15)(16)(17)(18)(19). Store-and-forward telemedicine involves a specialist's review of a recorded health history with digital images or video.…”

Section: Overview Of Telemedicinementioning

confidence: 99%

“…In a study in the United Kingdom, pediatric otolaryngology consultations by telemedicine were shown to be feasible and to reduce costs by 30% when compared to face-to-face visits (54). A child telepsychiatry consult system serving publicly insured children as well as children in foster care in Wyoming reduced outliers in psychotropic medication prescribing, was well accepted by community clinicians, prevented admissions to residential treatment facilities, and reduced costs of care (19). Another model of care that uses telehealth is one which encompasses provider education and case reviews as opposed to direct patient care.…”

Section: Subspecialty Carementioning

confidence: 99%

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Addressing health disparities in rural communities using telehealth

2015

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The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists' geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.

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Section: Overview Of Telemedicinementioning

confidence: 99%

Section: Subspecialty Carementioning

confidence: 99%

Addressing health disparities in rural communities using telehealth

2015

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“…Some states leverage telepsychiatry services to ease emergency department congestion and coordinate mental health services, often preventing expensive inpatient services (9). Telepsychiatry has also been effective in reducing Medicaid costs and the need for psychotropic medication among children with high needs (10). Collaborative care that includes video access to behavioral health specialty providers has the potential to increase access, improve quality, and lower costs, but adoption of the model is limited by the lack of enabling policies, reimbursement options, clinical training and education, and technology at the point of care.…”

mentioning

confidence: 99%

Assessing Telemedicine Utilization by Using Medicaid Claims Data

Douglas¹,

Xu²,

Heggs³

et al. 2017

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Objective This study characterized telemedicine utilization among Medicaid enrollees by patients’ demographic characteristics, geographic location, enrollment type, eligibility category, and clinical conditions. Methods This study used 2008–2009 Medicaid claims data from 28 states and the District of Columbia to characterize telemedicine claims (indicated by GT for professional fee claims or Q3014 for facility fees) on the basis of patients’ demographic characteristics, geographic location, enrollment type, eligibility category, and clinical condition as indicated by ICD-9 codes. States lacking Medicaid telemedicine reimbursement policies were excluded. Chi-square tests were used to compare telemedicine utilization rates and one-way analysis of variance was used to estimate mean differences in number of telemedicine encounters among subgroups. Results A total of 45,233,602 Medicaid enrollees from the 22 states with telemedicine reimbursement policies were included in the study, and .1% were telemedicine users. Individuals ages 45 to 64 (16.4%), whites (11.3%), males (8.5%), rural residents (26.0%), those with managed care plans (7.9%), and those categorized as aged, blind, and disabled (28.1%) were more likely to receive telemedicine (p<.001). Nearly 95% of telemedicine claims were associated with a behavioral health diagnosis, of which over 50% were for bipolar disorder and attention-deficit disorder or attention-deficit hyperactivity disorder (29.3% and 23.4%, respectively). State-level variation was high, ranging from .0 to 59.91 claims per 10,000 enrollees (Arkansas and Arizona, respectively). Conclusions Despite the touted potential for telemedicine to improve health care access, actual utilization of telemedicine in Medicaid programs was low. It was predominantly used to treat behavioral health diagnoses. Reimbursement alone is insufficient to support broad utilization for Medicaid enrollees.

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“…Telehealth 34 provides a promising solution that allows primary care providers (PCPs) and specialty care providers to engage in systems for care coordination, communication, and collaboration, particularly when true, in-person integration of separate systems is not possible. [35][36][37][38][39][40][41][42][43][44][45][46] Under the current referral structure and process, parents must navigate a complex multistep referral and care process once the referral to a CMHC has been initiated by a PCP. To improve access to specialty MH care, we partnered with a multisite federally qualified health center (FQHC) and 2 CMHCs to design and test an innovative telehealth-based structure and process for the MH referral process, with a goal of enhancing access to subspecialty MH care.…”

mentioning

confidence: 99%

A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial

Coker

Porras-Javier

Zhang³

et al. 2019

Pediatrics

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OBJECTIVES: To improve the mental health (MH) referral process for children referred from primary care to community mental health clinics (CMHCs) by using a community-partnered approach.METHODS: Our partners were a multisite federally qualified health center and 2 CMHCs in Los Angeles County. We randomly assigned 6 federally qualified health center clinics to the intervention or as a control and implemented a newly developed telehealth-enhanced referral process (video orientation to the CMHC and a live videoconference CMHC screening visit) for all MH referrals from the intervention clinics. Our primary outcome was CMHC access defined by completion of the initial access point for referral (CMHC screening visit). We used multivariate logistic and linear regression to examine intervention impact on our primary outcome. To accommodate the cluster design, we used mixed-effect regression models.RESULTS: A total of 342 children ages 5 to 12 were enrolled; 86.5% were Latino, 61.7% were boys, and the mean age at enrollment was 8.6 years. Children using the telehealth-enabled referral process had 3 times the odds of completing the initial CMHC screening visit compared with children who were referred by using usual care procedures (80.49% vs 64.04%; adjusted odds ratio 3.02 [95% confidence interval 1.47 to 6.22]). Among children who completed the CMHC screening visit, intervention participants took 6.6 days longer to achieve it but also reported greater satisfaction with the referral system compared with controls. Once this initial access point in referral was completed, .80% of eligible intervention and control participants (174 of 213) went on to an MH visit.CONCLUSIONS: A novel telehealth-enhanced referral process developed by using a communitypartnered approach improved initial access to CMHCs for children referred from primary care.

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A Statewide Child Telepsychiatry Consult System Yields Desired Health System Changes and Savings

Cited by 39 publications

References 18 publications

Addressing health disparities in rural communities using telehealth

Addressing health disparities in rural communities using telehealth

Assessing Telemedicine Utilization by Using Medicaid Claims Data

A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial

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