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Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
Mc Connochie
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Mc Connochie
Mc Connochie
Mc Connochie
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Mc Connochie

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  • Most people think of telemedicine as second-best, something you might resort to when great distance makes for difficult access to usual care. We want you to consider whether telemedicine might offer better care, even for common problems in urban settings … whether, in a sense, virtual is better than reality Given your expertise, the National Resource Center for HIT is inviting you to speak during the session, “Improving Quality Care for Children through HIT.” The focus of this session will include a discussion around the implementation of HIT developed to improve the safety and quality of health care for children.  The following three people have also been invited to participate in this session: Carmen Lozzio, MD, FACMG; Paula Edwards, MD; and Richard Shiffman. Each speaker will have 15 minutes to present, followed by questions from the audience. The session, “Improving Quality Care for Children through HIT” is scheduled for Wednesday, September 26, 2007 from 8:00 am – 9:30 am. NEED TO ADD: Characteristics of TeA model that enable integration. Text that links access and care delivered by PC practice to quality.
  • Transcript

    • 1. Telemedicine Integrated in the Primary Care Medical Home: When Virtual is Better than Reality Kenneth McConnochie Neil Herendeen Nancy Wood Division of General Pediatrics
    • 2. Program Funding Acknowledgements <ul><li>US Dept of Commerce Technology Opportunities Program </li></ul><ul><li>Robert Wood Johnson Local Initiative Funding Partners Program </li></ul><ul><li>Rochester Area Community Foundation </li></ul><ul><li>Maternal and Child Health Bureau R40 MC03605 </li></ul><ul><li>Agency for Healthcare Research and Quality R01 HS15165 </li></ul>Disclosure N. Herendeen, K. McConnochie and N. Wood hold equity positions in Tel-e-Atrics, Inc., a vendor of telemedicine equipment, hosting and support services
    • 3. The Problem – Community Perspective <ul><li>Majority of US preschool children are in child care </li></ul><ul><li>Acute illness more common among children in child care </li></ul><ul><li>For parents using child care, a child’s illness accounts for 40% of work absence </li></ul><ul><li>Over 50% of working mothers will miss work the next time one of their children is ill </li></ul>
    • 4. Related Problem – Pediatrician’s Perspective <ul><li>Retail-based clinics (RBCs) appeal to families </li></ul><ul><li>RBCs being developed by Wal-Mart, Targets, CVS, Walgreen and others </li></ul><ul><li>RBCs have the capacity to address most minor acute illness episodes that generate 52% of office visits* for children < 15 years </li></ul><ul><li>RBCs appeal to public and private payers </li></ul><ul><li>RBCs threaten continuity of care </li></ul><ul><ul><ul><li>* 2004 National Ambulatory Medical Care Survey </li></ul></ul></ul>
    • 5.  
    • 6.  
    • 7. A Solution: Health-e-Access <ul><li>Child care site - child with health problem, telehealth assistant </li></ul><ul><li>Remote clinician site - physician or nurse practitioner </li></ul><ul><li>Telehealth technology – broadband communications link, computer-driven digital sensors </li></ul>
    • 8.  
    • 9.  
    • 10. How it works <ul><li>Health problem identified by child care or by parent </li></ul><ul><li>Schedule a visit - page the telehealth clinician </li></ul><ul><li>Telehealth assistant prepares for visit </li></ul><ul><li>Connect at the scheduled time </li></ul><ul><li>Information exchange - both real-time interaction </li></ul><ul><li>and store and forward </li></ul><ul><li>Prescription called to pharmacy when appropriate </li></ul><ul><li>Usually OK to remain in child care </li></ul>
    • 11. Impact on ADI
    • 12. Parent Satisfaction % of families Based on interviews with parent after first use of telemedicine. N = 229. ED Allowed to stay at work* Would choose child care with telemed over one without Saved parent trip to: Primary Care Physician After hours Yes Yes * Estimated time saved = 4.5 hours (SD 2.2) per telemed visit
    • 13. Population and Setting <ul><li>6 inner-city child care centers, Rochester, NY </li></ul><ul><li>Telemedicine initiated in stepwise fashion starting with first child care center in May 2001 </li></ul><ul><li>Observations on utilization among pre-school children May 2001 thru October 2006 </li></ul><ul><li>138 children per center </li></ul><ul><li>Medicaid covers 66% </li></ul>
    • 14. Population and Setting - continued <ul><li>5 participating urban primary care practices </li></ul><ul><li>Participating practices provide primary care for 71% of children in the 6 participating child care programs </li></ul><ul><li>Integration of telemedicine in these practices began May 2005 </li></ul>
    • 15. Stages of Program Development <ul><li>Pre-expansion : 5/8/01 - 9/30/04 </li></ul><ul><li>begins with first childcare telemed visit </li></ul><ul><li>Expansion : 10/1/04 - </li></ul><ul><li>Technology development - 7 months, </li></ul><ul><li>begins with receipt of expansion funding </li></ul><ul><li>Integration – begins May 2005 </li></ul><ul><li>- PC Practice installation/training: 11 months </li></ul><ul><li>- PC Practice ramp-up: 6 months, begins when all </li></ul><ul><li>PC Practice telemed systems functional and </li></ul><ul><li>training completed </li></ul>
    • 16. Visits by Stage May 2001 - October 2006
    • 17. Hypothesis The Health-e-Access telemedicine model can be integrated successfully in the primary care medical home to provide care for acute illness episodes identified in inner-city child care.
    • 18. Measures of Successful Integration <ul><li>Continuity of care – the proportion of telemedicine visits seen by the child’s regular primary care practice (PC Practice). </li></ul><ul><li>Telemed visit completion – the proportion of telemed visits attempted that are completed, defined as diagnosis decisions and treatment without subsequent, in-person physical exam, lab tests or treatment. </li></ul>
    • 19. Results <ul><li>Visit completed = 96%. </li></ul><ul><ul><li>Among the 1530 visits integration stage visits, 1474 (96%) had diagnosis and management decisions based entirely on telemed model </li></ul></ul><ul><li>Continuity of care with PC Practice = 87% </li></ul><ul><li> - vs. continuity of care for RBCs = 0% </li></ul><ul><li>- practice to practice variation 50% - 93% </li></ul><ul><li>182 telemed visits/100 children/yr </li></ul>
    • 20. Conclusions Health-e-Access can be integrated in busy primary care practices serving urban children, enabling… <ul><li>exceptional access </li></ul><ul><li>completion of almost all illness visits </li></ul><ul><li>continuity of care (unlike retail based clinics) </li></ul>
    • 21. Confronted with new technology, organizations have 3 options … - ignore it and die, - adapt and survive, - lead and prosper Michael Leavitt, Secretary US Department of Health and Human Services
    • 22. Implications Healthcare - when and where you need it, - by people you know and trust.
    • 23. Thanks!
    • 24. Parachutes and Gravitational challenge Parachute use to prevent death and major trauma related to gravitational challenge: systematic review* * Smith GCS, Pell JP. British Medical Journal 2003:327:1459-61 Conclusion : Parachutes appear to reduce the risk of injury after gravitational challenge, but their effectiveness has not been proven with randomized controlled trials.
    • 25. Diagnosis Distribution
    • 26.  

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