Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Abstract

Objective: To evaluate the safety and efficacy of premature infant treatment managed by hybrid telemedicine versus conventional care. Methods: Prospective, noninferiority study comparing outcomes of premature infants at Comanche County Memorial Hospital's (CCMH) Level II neonatal intensive care unit (NICU) with outcomes at OU Medical Center's (OUMC) Level IV NICU. All 32-35 weeks gestational age (GA) infants admitted between May 2015 and October 2017 were included. Infants requiring mechanical ventilation >24 h or advanced subspecialty care were excluded. Outcome variables were: length of stay (LOS), respiratory support, and time to full per oral (PO) feeds. Parents at both centers were surveyed about their satisfaction with the care provided. Between-group comparisons were performed by using Chi-square or Fisher's exact test. LOS was assessed for normality by using the Shapiro-Wilk test, and robust regression was used to construct a multivariable regression model to test the independent effect of location on LOS. All analyses were performed by using SAS v. 9.3 (SAS Institute, Cary, NC). Results: Data from 85 CCMH and 70 OUMC neonates were analyzed. CCMH neonates had significantly shorter LOS, reached full PO feeds sooner, and had fewer noninvasive ventilation support days. Location had a significant independent effect (p = 0.001) on LOS while controlling for GA, gender, race, surfactant use, inborn/outborn status, and 5-min APGAR scores. CCMH patients had reduced LOS of 3.01 days (95% confidence interval 1.1-4.8) than OUMC patients. Eighty-five surveys at CCMH and 66 at OUMC were analyzed. Compared with CCMH, OUMC parents reported more travel distance difficulties. 92.5% reported telemedicine experience as good or excellent, whereas 1.5% reported it as poor. Conclusion(s): Hybrid telemedicine is a safe and effective way to extend intensive neonatal care to medically underserved areas. Parental satisfaction with use of hybrid telemedicine is high and comparable to conventional care.

A 360 Evaluation of Neonatal Care Quality at a Level II Neonatal Intensive Care Unit when Delivered Using a Hybrid Telemedicine Service

“…When compared to the results of our earlier prospective study [9], parents' assessment of the sound and picture quality were essentially the same, however their overall satisfaction in the current study (77.5%) is lower than those participating in our previous study (92.7%). A possible reason for the lower overall quality rating is that this study included NICU cases seen during the covid-19 pandemic, during which parents' ability to visit the unit and participate in their child's treatment was significantly different.…”

“…Telemedicine use in neonatology has largely been limited to consultation, teleechocardiography, retinopathy of prematurity screening, neonatal resuscitation program education, post discharge follow-up and family engagement [5,6]. To date, there are few scientific studies reporting on the feasibility and evaluation of telemedicine use as a primary means of providing care to premature infants in the NICU [7][8][9][10][11].…”

“…Evaluation of the efficacy of this program has been demonstrated in recently published studies. These reports compare the quality of care that clinically-matched patients receive through the hybrid telemedicine program at CCMH's Level II NICU with that available at OUMC's Level IV NICU, both retrospectively [8] and prospectively [9]. Both of these studies found that the services delivered via hybrid telemedicine were not inferior to those offered by standard care delivered at a Level IV NICU.…”

“…Satisfaction Survey. The surveys developed by Zailani, et al [16] and Wernhart, et al [17] served as the basis for the survey used this study, along with the knowledge and experiences gained by the authors during the design and implementation of the two previous research studies in our health system [8,9]. Satisfaction surveys consisted of five-point Likert scale questions…”

Evaluation and Management of Misophonia Using a Hybrid Telecare Approach: A Case Report

“…[30][31][32] Data specific to the implementation of management of DST via telehealth are limited. Additionally, although a hybrid telemedicine approach (a combination of in-person care and remote interactions) has been used in various clinical settings, [33][34][35] there are limited data related to using this approach for tinnitus and DST.…”