McConnochie Kenneth M, Tan Jonathan, Wood Nancy E, Herendeen Neil E, Kitzman Harriet J, Roy Jason, Roghmann Klaus J
Department of Pediatrics, University of Rochester, Rochester, New York, USA.
Telemed J E Health. 2007 Aug;13(4):381-90. doi: 10.1089/tmj.2006.0070.
The ready access provided by telemedicine benefits families and society but might increase total healthcare utilization with uncertain implications for costs. The objective of this study was to assess the net impact on healthcare utilization of introducing into inner-city childcare a telemedicine model designed to manage acute illness. A cohort study was done using comparable periods before and after introduction of telemedicine for all qualifying children (n = 112) using three innercity childcare centers. Because the utilization histories of these children differed in length, we chose child-months as the unit of analysis. Acute illness visits were ascertained for 1806 child-months among the 112 qualifying children. Following telemedicine startup, children's office and emergency department (ED) visits for illness fell by 1.73 and 0.20/child/year, respectively, replaced by telemedicine visits at 1.07/year. These observations could be misleading, however, because of the possibility of confounding factors. For example, the cohort aged during observation, and illness visits fall with age. Accordingly, in multivariate analysis we adjusted for season of the year, age, and within-child correlation. In this analysis, reduction in illness utilization overall tended toward an increase (rate ratio = 1.26, p = 0.13). The worst-case estimate (based on upper 95% confidence interval for rate ratio) for increase in illness utilization was 3.38 visits/child/year, and the most likely case was an increase of 1.26. Assuming (1) the worst-case effect (largest increase) on overall utilization and (2) reimbursement for ED, office, and telemedicine visits of 350 dollars, 45 dollars, and 45 dollars, respectively, the healthcare system would break even on telemedicine if it replaced 0.50 ED visits per child annually.
远程医疗提供的便捷服务使家庭和社会受益，但可能会增加医疗保健的总利用率，对成本产生不确定的影响。本研究的目的是评估将旨在管理急性疾病的远程医疗模式引入市中心儿童保育机构对医疗保健利用率的净影响。我们对使用三个市中心儿童保育中心的所有符合条件的儿童（n = 112）在引入远程医疗之前和之后的可比时期进行了队列研究。由于这些儿童的就诊历史长度不同，我们选择儿童月作为分析单位。在112名符合条件的儿童中，确定了1806个儿童月的急性疾病就诊情况。远程医疗启动后，儿童因疾病到诊所和急诊科就诊的次数分别下降了1.73次/儿童/年和0.20次/儿童/年，取而代之的是每年1.07次的远程医疗就诊。然而，这些观察结果可能会产生误导，因为存在混杂因素的可能性。例如，队列在观察期间年龄增长，疾病就诊次数会随着年龄增长而下降。因此，在多变量分析中，我们对一年中的季节、年龄和儿童内部相关性进行了调整。在该分析中，疾病利用率的总体下降趋势倾向于增加（率比 = 1.26，p = 0.13）。疾病利用率增加的最坏情况估计（基于率比的95%置信区间上限）为3.38次/儿童/年，最可能的情况是增加1.26次。假设（1）对总体利用率产生最坏情况的影响（最大增加），以及（2）急诊科、诊所和远程医疗就诊的报销费用分别为350美元、45美元和45美元，如果远程医疗每年替代每个儿童0.50次急诊科就诊，医疗保健系统在远程医疗方面将实现收支平衡。
