The Impact of Telehealth and Care Coordination on the Number and Type of Clinical Visits for Children With Medical Complexity

McKissick, Holly D.; Cady, Rhonda; Looman, Wendy S.; Finkelstein, Stanley M.

doi:10.1016/j.pedhc.2016.11.006

Cited by 34 publications

(32 citation statements)

References 20 publications

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“…Those published focus on the use of videoconferencing alone and demonstrated that videoconferencing increases family satisfaction, and decreases travel, ED, office visits, and hospitalizations for CMC. 13,14…”

Section: Introductionmentioning

confidence: 99%

Home-Based Telemedicine for Children with Medical Complexity

Notario

Gentile

Amidon

et al. 2019

Telemedicine and e-Health

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Background: Children with medical complexity (CMC) are high utilizers of health care services. Telehealth encounters may provide a means to improve care outcomes for this population.Objective: To evaluate the feasibility, usability, and impact of an in-home telehealth device in the care of CMC.Methods: This single-center feasibility study employed a nonblinded randomized clinical trial design. English-speaking caregivers of children within a pediatric complex care program with home Wi-Fi were eligible for participation. Participants were randomized 1.5:1 with stratification based on tracheostomy status to a control group that received usual care or an intervention group that received a telehealth device for in-home use. Patients were followed up for 4 months. The primary outcome was successful device connectivity and data transmission. Data included clinician encounter device usability; caregiver satisfaction; and encounter type, purpose, and cost. Descriptive statistics, negative binomial regression, and Kaplan–Meier plot were used for analysis.Results: Twenty-four patients were enrolled (9 controls, 15 in the intervention group) in September 2016. The telehealth device was attempted in 73 encounters. Device connectivity was successful 96% of the time. Image and sound quality were acceptable in 98% of visits. Caregivers expressed their overall satisfaction with the device. The hospitalization rate was lower in the intervention group (0.77 vs. 1.14 intensive care unit days/patient-months), resulting in $9,425/USD per patient savings compared with the control group.Conclusion: Despite small sample size and short observation period, this study demonstrated that use of an in-home telehealth device is feasible, well received by caregivers, and can result in decreased hospitalizations when compared with usual care.

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Section: Introductionmentioning

confidence: 99%

Home-Based Telemedicine for Children with Medical Complexity

Notario

Gentile

Amidon

et al. 2019

Telemedicine and e-Health

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“…15 Providing care coordination via telehealth also was associated with a decrease in unplanned visits. 16 In a further study, interviews with health care providers involved in care coordination demonstrated that success with care coordination generally involved proactive rather than reactive coordination of services, providing services such as pre-visit assessments, and using family questionnaires regarding priorities and goals, as well as written care plans. 27 Despite a growing evidence base on successes with care coordination, some challenges remain.…”

Section: Discussionmentioning

confidence: 98%

“…14 Several organizations recently have reported success with adopting new methods of care coordination. [15][16][17] The Patient Protection and Affordable Care Act (ACA) may have provided further impetus to implement health care coordination initiatives. 18 Increasing adoption of care coordination services for CSHCN could have reduced disparities in access to care coordination, as compared to disparities noted in studies using older data.…”

Section: Introductionmentioning

confidence: 99%

Unmet Need for Care Coordination Among Children with Special Health Care Needs

Miller

Tumin

Hayes

et al. 2019

Population Health Management

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Socioeconomic disparities in access to care coordination have been noted among children with special health care needs (CSHCN). Following recent policy developments and technological innovation, care coordination has become more widespread, possibly leading to reduced disparity in care coordination access. This study investigates whether child and household characteristics remain associated with unmet need for care coordination among CSHCN. CSHCN (aged <18 years) requiring ‡2 types of health services in the past year were identified in the 2016 National Survey of Children's Health (NSCH). Care coordination was defined as help with arranging the child's care among different doctors or services. Children were classified as not needing care coordination, receiving sufficient care coordination (met need), or needing but not receiving care coordination (unmet need). Weighted multinomial logistic regression examined the association of child characteristics with this outcome. The analysis included 5622 children with no need for care coordination, 1466 with a met need, and 980 with unmet needs. Children with mental health conditions were more likely to have unmet rather than met needs for care coordination (odds ratio = 4.1; 95% confidence interval: 2.7, 6.1; P < 0.001). After multivariable adjustment, race/ethnicity, income, family structure, insurance coverage, place of birth, and use of English in the home were not associated with having unmet rather than met needs for care coordination. Among CSHCN, the latest data from NSCH reveal no evidence of previously described socioeconomic disparities in access to care coordination. Nevertheless, unmet needs for care coordination remain prevalent, especially among children with mental health conditions.

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“…Their study showed that online asthma management is both clinically effective and cost-effective and can partly replace outpatient visits [ 9 ]. Study by McKissick et al showed that telehealth intervention delivered by advanced practice registered nurse to children with medical complexity led to reduction in number of unplanned health care visits (due to acute deterioration in child’s condition) and increase in planned visit (for regular health maintenance) [ 10 ].…”

Section: Discussionmentioning

confidence: 99%