Hospital Utilization Among Rural Children Served by Pediatric Neurology Telemedicine Clinics

Dayal, Parul; Chang, Celia H.; Benko, William; Pollock, Brad H.; Crossen, Stephanie S.; Kissee, Jamie L.; Ulmer, Aaron M.; Hoch, Jeffrey S.; Warner, Leslie; Marcin, James P.

doi:10.1001/jamanetworkopen.2019.9364

Cited by 32 publications

(29 citation statements)

References 30 publications

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“…16 Two-way video/webcam technologies are being used by almost twothirds of hospitals in 2019, which has significantly increased from less than half in 2016. 16,17…”

Section: Competitive Advantagementioning

confidence: 99%

Telehealth: Advances in Alternative Payment Models

Zhao

Hamadi

Haley

et al. 2020

Telemedicine and e-Health

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Introduction: The hospital sector has shifted its focus to advanced information and communication technologies to facilitate health care delivery through telehealth services to alleviate the industry's most pressing challenges in quality care and access, especially under changing reimbursement payment approaches. The aim of this study was to examine the association between alternative payment models (APMs), market competition, and telehealth provisions in the hospital setting. Materials and Methods: A secondary cross-sectional design to analyze 2018 census data of nonfederal short-term acute care hospitals in the United States was used. Multilevel logistic regressions models were used to analyze data from 4,257 hospitals across 1,874 counties. Counties with less than one hospital were excluded. Results: Regarding APMs, we found that hospital participation in accountable care organizations and participation in a bundled payment risk arrangement are significantly associated with the provision of telehealth services. From the market perspective, competitive advantage was found to be statistically associated with hospitals providing telehealth services. In addition, other hospital characteristics such as ownership, part of a system, part of a network, and major teaching affiliation also have impact on the provision of telehealth. Conclusions: The increase uptake of telehealth-related capabilities and their strong integration into care-delivery systems under APMs present exciting opportunities to enhance the merit of clinical care, and challenges as clinical professionals are not adept to using such technologies. There is a need to provide comprehensive of evidence on telehealth.

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“…16 Two-way video/webcam technologies are being used by almost twothirds of hospitals in 2019, which has significantly increased from less than half in 2016. 16,17…”

Section: Competitive Advantagementioning

confidence: 99%

Telehealth: Advances in Alternative Payment Models

Zhao

Hamadi

Haley

et al. 2020

Telemedicine and e-Health

View full text Add to dashboard Cite

show abstract

“…[5][6][7][8][9][10][11] Reports of pediatric neurology telemedicine delivery have been limited to programs for under-served populations. 12,13 Here, we analyzed the implementation of telehealth services in our large pediatric neurology care network, including scheduled telephone encounters and newly implemented audio-video telemedicine encounters. As audio-video telemedicine encounters represented a new modality of patient care, we performed a quality improvement study to determine the effectiveness of telemedicine encounters as assessed by the clinicians, the utility of telemedicine for future care, the need for short-term in-person follow-up, and patient/caregiver satisfaction with the telemedicine experience.…”

Section: Introductionmentioning

confidence: 99%

“… 5 – 11 Reports of pediatric neurology telemedicine delivery have been limited to programs for underserved populations. 12 , 13 …”

mentioning

confidence: 99%

Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic

et al. 2020

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Objective:To assess the rapid implementation of child neurology telehealth outpatient care with the onset of the COVID-19 pandemic in March 2020.Methods:This was a cohort study with retrospective comparison of 14,780 in-person encounters and 2,589 telehealth encounters including 2,093 audio-video telemedicine and 496 scheduled telephone encounters between 10/1/19 and 4/24/2020. We compared in-person and telehealth encounters for patient demographics and diagnoses. For audio-video telemedicine encounters, we analyzed questionnaire responses addressing provider experience, follow-up plans, technical quality, need for in-person assessment, and parent/caregiver satisfaction. We performed manual reviews of encounters flagged as concerning by providers.Results:There were no differences in patient age and major ICD10 codes before and after transition. Clinicians considered telemedicine satisfactory in 93% (1200/1286) of encounters and suggested telemedicine as a component for follow-up care in 89% (1144/1286) of encounters. Technical challenges were reported in 40% (519/1314) of encounters. In-person assessment was considered warranted following 5% (65/1285) of encounters. Patients/caregivers indicated interest in telemedicine for future care in 86% (187/217) of encounters. Participation in telemedicine encounters compared to telephone encounters was less frequent amongst patients in racial or ethnic minority groups.Conclusions:We effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters. Providers rated the vast majority of telemedicine encounters to be satisfactory, and only a small proportion of encounters required short-term in-person follow-up. These findings suggest telemedicine is feasible and effective for a large proportion of child neurology care. Additional strategies are needed to ensure equitable telemedicine utilization.

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“…The use of new technology has been proven to be beneficial, particularly so in rural and less wealthy areas where telemedicine has been used for neurological diseases [23] and diabetes [24]. With this in mind, we believe that improving access to technology in poor areas could level the playing field for healthcare disparities.…”

Section: Potential Solutionsmentioning

confidence: 99%

Social Inequality and Diabetes: A Commentary

Barnard‐Kelly

Cherñavvsky

2020

Diabetes Ther

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Socioeconomic inequality of access to healthcare is seen across the spectrum of healthcare, including diabetes. Health inequalities are defined as the 'preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness or opportunities to take action and access treatment when ill health occurs' (NHS England; https://www. england.nhs.uk/about/equality/equality-hub/re sources/). Access to diabetes technologies has improved glycaemic and quality-of-life outcomes for many users. Inability to access such devices, however, is evidenced in National Diabetes Audit data, with a reported tenfold variation in insulin pump use by people with type 1 diabetes across specialist centres. This variation suggests a lack of access to healthcare systems that should be investigated. This article highlights some of the key issues surrounding healthcare inequalities in the management of diabetes.

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Hospital Utilization Among Rural Children Served by Pediatric Neurology Telemedicine Clinics

Cited by 32 publications

References 30 publications

Telehealth: Advances in Alternative Payment Models

Telehealth: Advances in Alternative Payment Models

Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic

Social Inequality and Diabetes: A Commentary

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