McConnochie Kenneth M, Ronis Sarah D, Wood Nancy E, Ng Phillip K
1 Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center , Rochester, New York.
2 Department of Emergency Medicine, University of Rochester Medical Center , Rochester, New York.
Telemed J E Health. 2015 Aug;21(8):611-21. doi: 10.1089/tmj.2014.0175. Epub 2015 Apr 3.
To assess the hypothesis that effectiveness and safety of the Health-e-Access telemedicine model for care of children with special healthcare needs (CSHCN) with acute illness equaled those for care of children in regular childcare and schools (CRS).
We examined healthcare use through insurance claims and telemedicine records spanning 5.7 and 7.3 years for CSHCN and CRS, respectively. Effectiveness was measured as telemedicine visit completion, duplication, and adverse events. Completed visits had diagnosis and management decisions made, and treatment implemented, based solely on telemedicine. Duplicating visits addressed related problems in-person following telemedicine visits within 1 or 3 days. An adverse event was defined as an emergency department visit following a telemedicine visit within 3 days for a problem probably related.
Comparisons addressing these measures included 483 and 10,008 telemedicine visits by CSHCN and CRS, respectively. Claims files captured health services use for varying periods of time among 300 different CSHCN and among 1,950 different CRS. Among the 483 telemedicine visits initiated for CSHCN over their telemedicine observation period, 9 were not completed. The CSHCN completion rate of 98.1% equaled the 97.6% completion observed among CRS. Within 3 days, in-person visits duplicated 16.1% of telemedicine visits for both CSHCN and CRS. Within 1 day, in-person visits duplicated 5.3% and 8.9% of telemedicine visits for CSHCN and CRS, respectively. Adverse events following telemedicine visits included 0.3% of telemedicine visits for CSHCN and 0.5% for CRS.
Observations support safety and effectiveness of Health-e-Access telemedicine for both CSHCN and CRS.
评估“健康电子接入”远程医疗模式用于护理患有特殊医疗需求的急性病儿童（CSHCN）时，其有效性和安全性是否等同于用于护理常规儿童保育机构和学校中的儿童（CRS）。
我们通过保险理赔和远程医疗记录，分别对CSHCN和CRS在5.7年和7.3年期间的医疗保健使用情况进行了检查。有效性通过远程医疗就诊完成情况、重复就诊情况和不良事件来衡量。已完成的就诊仅基于远程医疗做出诊断、管理决策并实施治疗。重复就诊是指在远程医疗就诊后的1天或3天内亲自处理相关问题。不良事件定义为在远程医疗就诊后3天内因可能相关的问题而进行的急诊就诊。
针对这些指标的比较分别包括CSHCN的483次和CRS的10,008次远程医疗就诊。理赔文件记录了300名不同的CSHCN和1,950名不同的CRS在不同时间段内的医疗服务使用情况。在CSHCN的远程医疗观察期内发起的483次远程医疗就诊中，有9次未完成。CSHCN的完成率为98.1%，与CRS中观察到的97.6%的完成率相当。在3天内，CSHCN和CRS的亲自就诊重复了16.1%的远程医疗就诊。在1天内，CSHCN和CRS的亲自就诊分别重复了5.3%和8.9%的远程医疗就诊。远程医疗就诊后的不良事件在CSHCN中占远程医疗就诊的0.3%，在CRS中占0.5%。
观察结果支持“健康电子接入”远程医疗对CSHCN和CRS均具有安全性和有效性。
