Using Telehealth to Care for Children with Medical Complexity

Gentile, Elise Madeck; Notario, Patricia M.; Amidon, Matthew; Angst, Denise; Lefaiver, Cheryl; Webster, Kathleen

doi:10.1016/j.pedhc.2019.04.005

Cited by 2 publications

(1 citation statement)

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“…It will also be important to consider how increased use of telemedicine in the post-COVID landscape may change how care coordinators allocate time. Virtual visits have been reported as feasible for the care and care coordination of children with medical complexity, [29][30][31] allowing care coordinators to join medical visits or do care coordination directly in the home. In this study, outpatient care coordinators reported a significant amount of time traveling to appointments and home visits.…”

Section: Discussionmentioning

confidence: 99%

Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity

Dallas

Ryan

Mestan

et al. 2022

Advances in Neonatal Care

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Background: Parents in the neonatal intensive care unit (NICU) report low self-confidence managing their children's ongoing medical and social needs. While bedside nurses provide critical support for families throughout their NICU admission, there may be a role for nursing coordination throughout hospitalization, discharge, and in the transition to outpatient care. Purpose: This program evaluation explores parent and provider experiences of a novel longitudinal care coordination program for infants with medical complexity from the NICU through their first year of life post-discharge. Methods: First, a sequential exploratory mixed-methods approach was used to evaluate parental experiences (n = 5 interviewed followed by n = 23 surveyed). Provider perspectives were elicited through semi-structured interviews (n = 8) and focus groups (n = 26 in 3 groups). Results: Parent-reported benefits included frequent communication and personalized support that met families' and patients' evolving needs. Care coordinators, who were trained as nurses and social workers, developed longitudinal relationships with parents. This seemed to facilitate individualized support throughout the first year of life. Providers reported that smaller caseloads were central to the success of the program. Implications for Practice and Research: This longitudinal care coordination program can be used as a translatable model in NICUs elsewhere to address the unique needs of families of infants with medical complexity throughout the first year of life. Future implementations should consider how to expand program size while maintaining individualized supports. As the care coordinators are former NICU nurses and social workers, there may be a growing role for nursing coordination of care in the neonatal population.

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Section: Discussionmentioning

confidence: 99%

Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity

Dallas

Ryan

Mestan

et al. 2022

Advances in Neonatal Care

View full text Add to dashboard Cite

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Appointment completion in pediatric neurology telemedicine clinics serving underserved patients

et al. 2019

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BackgroundTo determine whether telemedicine improves access to outpatient neurology care for underserved patients, we compared appointment completion between urban, in-person clinics and telemedicine clinics held in rural and underserved communities where neurology consultations are provided remotely.MethodsIn this retrospective study, we identified patients scheduled for outpatient care from UCDH pediatric neurologists between January 1, 2009, and July 31, 2017, in person and by telemedicine. Demographic and clinical variables were abstracted from electronic medical records. We evaluated the association between consultation modality and visit completion in overall and matched samples using hierarchical multivariable logistic regression.ResultsWe analyzed 13,311 in-person appointments by 3,831 patients and 1,158 telemedicine appointments by 381 patients. The average travel time to the site of care was 45.8 ± 52.1 minutes for the in-person cohort and 22.3 ± 22.7 minutes for the telemedicine cohort. Telemedicine sites were located at an average travel time of 217.1 ± 114.8 minutes from UCDH. Telemedicine patients were more likely to have nonprivate insurance, lower education, and lower household income. They had different diagnoses and fewer complex chronic conditions. Telemedicine visits were more likely to be completed than either “cancelled” or missed (“no show”) compared with in-person visits (OR 1.57, 95% CI: 1.34–1.83; OR 1.66, 95% CI: 1.31–2.10 matched on travel time to the site of care; OR 2.22, 95% CI: 1.66–2.98 matched on travel time to UCDH).ConclusionsThe use of telemedicine for outpatient pediatric neurology visits has high odds of completion and can serve as an equal adjunct to in-person clinic visits.

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Using Telehealth to Care for Children with Medical Complexity

Cited by 2 publications

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Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity

Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity

Appointment completion in pediatric neurology telemedicine clinics serving underserved patients

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