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Telemedicine Integrated in the Primary Care Medical Home: When Virtual is Better than Reality   Kenneth McConnochie Neil H...
Program Funding Acknowledgements <ul><li>US Dept of Commerce Technology Opportunities Program </li></ul><ul><li>Robert Woo...
The Problem –  Community Perspective <ul><li>Majority of US preschool children are in child care </li></ul><ul><li>Acute i...
Related Problem –  Pediatrician’s Perspective <ul><li>Retail-based clinics  (RBCs) appeal to families </li></ul><ul><li>RB...
 
 
A Solution:  Health-e-Access <ul><li>Child care site  - child with health problem, telehealth assistant </li></ul><ul><li>...
 
 
How it works <ul><li>Health problem identified by child care or by parent </li></ul><ul><li>Schedule a visit - page the te...
Impact on ADI
Parent Satisfaction % of families Based on interviews with parent after first use of telemedicine.  N = 229. ED Allowed to...
Population and Setting <ul><li>6 inner-city child care centers, Rochester, NY  </li></ul><ul><li>Telemedicine initiated in...
Population and Setting -  continued <ul><li>5 participating urban primary care practices </li></ul><ul><li>Participating p...
Stages of Program Development <ul><li>Pre-expansion :  5/8/01 - 9/30/04 </li></ul><ul><li>begins with first childcare tele...
Visits by Stage May 2001 - October 2006
Hypothesis The Health-e-Access telemedicine model can be integrated successfully in the primary care medical home to provi...
Measures of Successful Integration <ul><li>Continuity of care  – the proportion of telemedicine visits seen by the child’s...
Results <ul><li>Visit completed = 96%.  </li></ul><ul><ul><li>Among the 1530 visits integration stage visits, 1474 (96%) h...
Conclusions Health-e-Access can be integrated in busy primary care practices serving urban children, enabling… <ul><li>exc...
Confronted with new technology, organizations have 3 options … - ignore it and die, - adapt and survive,  - lead and prosp...
Implications Healthcare - when and where you need it,  - by people you know and trust.
Thanks!
Parachutes and Gravitational challenge Parachute use to prevent death and major trauma related to gravitational challenge:...
Diagnosis Distribution
 
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Mc Connochie

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Mc Connochie

  1. 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. 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. 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. 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. 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>
  6. 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>
  7. 11. Impact on ADI
  8. 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
  9. 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>
  10. 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>
  11. 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>
  12. 16. Visits by Stage May 2001 - October 2006
  13. 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.
  14. 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>
  15. 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>
  16. 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>
  17. 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
  18. 22. Implications Healthcare - when and where you need it, - by people you know and trust.
  19. 23. Thanks!
  20. 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.
  21. 25. Diagnosis Distribution

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