Home-Based Telemedicine for Children with Medical Complexity

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. Met...

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Autores principales: Notario, Patricia M, Gentile, Elise, Amidon, Matthew, Angst, Denise, Lefaiver, Cheryl, Webster, Kathleen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mary Ann Liebert, Inc., publishers 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842894/
https://www.ncbi.nlm.nih.gov/pubmed/30628860
http://dx.doi.org/10.1089/tmj.2018.0186
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author Notario, Patricia M
Gentile, Elise
Amidon, Matthew
Angst, Denise
Lefaiver, Cheryl
Webster, Kathleen
author_facet Notario, Patricia M
Gentile, Elise
Amidon, Matthew
Angst, Denise
Lefaiver, Cheryl
Webster, Kathleen
author_sort Notario, Patricia M
collection PubMed
description 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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spelling pubmed-68428942019-11-12 Home-Based Telemedicine for Children with Medical Complexity Notario, Patricia M Gentile, Elise Amidon, Matthew Angst, Denise Lefaiver, Cheryl Webster, Kathleen Telemed J E Health Original 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. Mary Ann Liebert, Inc., publishers 2019-11-01 2019-11-06 /pmc/articles/PMC6842894/ /pubmed/30628860 http://dx.doi.org/10.1089/tmj.2018.0186 Text en © Patricia M Notario et al., 2019; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original
Notario, Patricia M
Gentile, Elise
Amidon, Matthew
Angst, Denise
Lefaiver, Cheryl
Webster, Kathleen
Home-Based Telemedicine for Children with Medical Complexity
title Home-Based Telemedicine for Children with Medical Complexity
title_full Home-Based Telemedicine for Children with Medical Complexity
title_fullStr Home-Based Telemedicine for Children with Medical Complexity
title_full_unstemmed Home-Based Telemedicine for Children with Medical Complexity
title_short Home-Based Telemedicine for Children with Medical Complexity
title_sort home-based telemedicine for children with medical complexity
topic Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842894/
https://www.ncbi.nlm.nih.gov/pubmed/30628860
http://dx.doi.org/10.1089/tmj.2018.0186
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