Implementation and Evaluation of a Neurology Telemedicine Initiative at a Major Academic Medical Center

Reider-Demer, Melissa; Jalilian, Laleh; Roy, Satavisha; Lee, John; Dong, Xuezhi; Hitson, Heather; Thomas, Erin; Grogan, Tristan; Simkovic, Michael; Kamdar, Nirav

doi:10.1089/tmj.2020.0502

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…We evaluated patient cost savings and satisfaction associated with telemedicine use in our patient population. To calculate patient costs saved by using telemedicine for care as opposed to an in-person visit, the patient’s total cost for an in-person visit was estimated by calculating and totaling the total fuel cost for travel by car to a clinic visit, parking cost, and time-based opportunity cost, based on previously published methods [ 12 , 13 ]. The round-trip travel time and round-trip travel distance were calculated using each patient’s originating zip code to that of their pain management clinic using Google Maps’ Distance Matrix application programming interface (Google).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Telemedicine Use for Anesthesiology Pain Division: Retrospective, Observational Case Series Study

Jalilian

Ing

et al. 2022

JMIR Perioper Med

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Background An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, health care providers have used telemedicine for pain management of both interventional patients and those with chronic pain. Objective In this study, we aimed to describe the implementation of a telemedicine program for pain management in an academic pain division in a large metropolitan area. We also aimed to estimate patient cost savings from telemedicine, before and after the California COVID-19 “Safer at Home” directive, and to estimate patient satisfaction with telemedicine for pain management care. Methods This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1398 patients and conducted 2948 video visits for remote pain management care. We used the publicly available Internal Revenue Service’s Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimated median travel time and travel distance with Google Maps’ Distance Matrix application programming interface, direct cost of travel with median value for regular fuel cost in California, and time-based opportunity savings from estimated hourly earnings and round-trip time. We reported patient satisfaction scores derived from a postvisit satisfaction survey containing questions with responses on a 5-point Likert scale. Results Patients who attended telemedicine visits avoided an estimated median round-trip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within the sample, their median hourly earnings were US $28 (IQR US $21-$39) per hour. Patients saved a median of US $22 on gas and parking and a median total of US $52 (IQR US $36-$75) per telemedicine visit based on estimated hourly earnings and travel time. Patients who were evaluated serially with telemedicine for medication management saved a median of US $156 over a median of 3 visits. A total of 91.4% (286/313) of patients surveyed were satisfied with their telemedicine experience. Conclusions Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for patients with pain. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings.

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Section: Methodsmentioning

confidence: 99%

Evaluation of Telemedicine Use for Anesthesiology Pain Division: Retrospective, Observational Case Series Study

Jalilian

Ing

et al. 2022

JMIR Perioper Med

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“…Especially in the context of the COVID-19 pandemic, virtual neurology encounters have been widely used to help facilitate equitable, safe, and reliable access to medical evaluation across a variety of geographic and clinical settings. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 Teleneurology-enabled hub-and-spoke model system design may also be used to democratize access to neurology expertise and to aid in appropriate triage of neurologically complex patients, including those with stroke and DoC. 59 60 61 Statements and resources made available by the American Medical Association (AMA), AAN, American Psychiatric Association, Centers for Medicare & Medicaid Services, American Academy of Physical Medicine and Rehabilitation, and other organizations have supported implementation of, and access to, telemedicine services, emphasizing themes of justice in their respective guidance and resources.…”

Section: Justice and Equity In Teleneurologymentioning

confidence: 99%

Neuroethics in the Era of Teleneurology

Young

2022

Semin Neurol

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The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation. Toward these ends, this article explores key ethical dimensions of teleneurology practice and policy, presents a normative framework for their consideration, and calls attention to underexplored questions ripe for further study at this evolving nexus of teleneurology and neuroethics. To promote successful and ethically resilient development of teleneurology across diverse contexts, clinicians, organizational leaders, and information technology specialists should work closely with neuroethicists with the common goal of identifying and rigorously assessing the trajectories and potential limits of teleneurology systems.

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“…Although considered an imperfect modality, telemedicine has increased access to medical care for patients and reduced consultation time, distance traveled, emission of environmental pollutants, and related costs while maintaining high patient satisfaction [4,8,[18][19][20][21]. The current literature also shows that telemedicine provides patients with time and cost-saving benefits while avoiding further day-of-surgery delays [8,22].…”

Section: Introductionmentioning

confidence: 99%

“…It can also be employed for timely screening and triaging of patients with suspected or established COVID-19 [ 10 , 13 ]. While telemedicine has been demonstrated to improve appointment adherence in nonsurgical and surgical specialties, there is limited knowledge of its effects on appointment adherence for preoperative anesthesia appointments [ 21 , 26 ]. Barriers to telemedicine implementation include the scarcity of standardized protocols, strict federal and state regulations, upfront costs, and education of healthcare personnel [ 13 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis

Le,

Burton,

Tejeda

et al. 2024

Cureus

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Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, the sudden demand for virtual medical visits drove the expansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge of the impact of telehealth on appointment adherence, particularly in preoperative anesthesia evaluations. This study aims to describe the impact of telemedicine-based anesthesia evaluation and its effects on appointment completion.Methods: This was a retrospective, non-randomized, cohort study of adult patients at the University of California, Los Angeles, United States, who received preoperative anesthesia evaluations by telemedicine or in-person in an academic medical center. From January to September 2021, we evaluated telemedicine and in-person appointment completion in patients scheduled for surgery. The primary outcome was the incidence of appointment completion. The secondary outcomes included appointment no-shows and cancellations.Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%), fewer cancellations (12.55% vs 19.41%), and no statistical difference in appointment no-shows (6.07% vs 3.99%). Compared to the in-person group, patients who received telemedicine evaluations were younger (55. 81 ± 18.38 vs 65.97 ± 15.19), less likely Native American and Alaska Native (0.31% vs 1.60%), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%), required less interpreter services (4.18% vs 9.31%), had more private insurance coverage (53.45% vs 37.50%) and less Medicare coverage (37.03% vs 50.53%).Conclusions: This study demonstrates that telemedicine can improve preoperative anesthesia appointment completion and decrease appointment cancellations. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured. These inequities highlight potential avenues to increase equity and access to telemedicine.

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Implementation and Evaluation of a Neurology Telemedicine Initiative at a Major Academic Medical Center

Cited by 10 publications

References 20 publications

Evaluation of Telemedicine Use for Anesthesiology Pain Division: Retrospective, Observational Case Series Study

Evaluation of Telemedicine Use for Anesthesiology Pain Division: Retrospective, Observational Case Series Study

Neuroethics in the Era of Teleneurology

Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis

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