Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York 10032, USA.
J Am Med Inform Assoc. 2010 Mar-Apr;17(2):196-202. doi: 10.1136/jamia.2009.002592.
Objective To determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention. Design We studied 1665 participants in the Informatics for Diabetes Education and Telemedicine (IDEATel), a randomized controlled trial comparing telemedicine case management of diabetes to usual care. Participants were aged 55 years or older, and resided in federally designated medically underserved areas of New York State. Measurements We analyzed Medicare claims payments for each participant for up to 60 study months from date of randomization, until their death, or until December 31, 2006 (whichever happened first). We also analyzed study expenditures for the telemedicine intervention over six budget years (February 28, 2000- February 27, 2006). Results Mean annual Medicare payments (SE) were similar in the usual care and telemedicine groups, $9040 ($386) and $9669 ($443) per participant, respectively (p>0.05). Sensitivity analyses, including stratification by censored status, adjustment by enrollment site, and semi-parametric weighting by probability of dropping-out, rendered similar results. Over six budget years 28 821 participant/months of telemedicine intervention were delivered, at an estimated cost of $622 per participant/month. Conclusion Telemedicine case management was not associated with a reduction in Medicare claims in this medically underserved population. The cost of implementing the telemedicine intervention was high, largely representing special purpose hardware and software costs required at the time. Lower implementation costs will need to be achieved using lower cost technology in order for telemedicine case management to be more widely used.
目的 确定糖尿病病例管理远程医疗干预是否通过医疗保险索赔降低了医疗支出，并评估开发和实施远程医疗干预的成本。
设计 我们研究了 1665 名参与信息学糖尿病教育和远程医疗（IDEATel）的参与者，这是一项比较糖尿病远程医疗病例管理与常规护理的随机对照试验。参与者年龄在 55 岁或以上，居住在纽约州指定的医疗服务不足的联邦地区。
测量 我们分析了每位参与者从随机分组日期到死亡或 2006 年 12 月 31 日（以先发生者为准）的最多 60 个研究月的医疗保险索赔支付情况。我们还分析了六年预算期（2000 年 2 月 28 日至 2006 年 2 月 27 日）的远程医疗干预研究支出。
结果 常规护理组和远程医疗组的平均年医疗保险支付（SE）相似，分别为每位参与者 9040 美元（386 美元）和 9669 美元（443 美元）（p>0.05）。包括按删失状态分层、按入组地点调整以及按辍学概率半参数加权的敏感性分析得出了类似的结果。在六年预算期内，共提供了 28821 名参与者/月的远程医疗干预，估计每名参与者每月的成本为 622 美元。
结论 在这个医疗服务不足的人群中，远程医疗病例管理与医疗保险索赔的减少无关。实施远程医疗干预的成本很高，主要代表当时所需的专用硬件和软件成本。为了使远程医疗病例管理得到更广泛的应用，需要使用成本更低的技术来降低实施成本。
