Bian John, Cristaldi Kathryn K, Summer Andrea P, Su Zemin, Marsden Justin, Mauldin Patrick D, McElligott James T
Department of Medicine, Medical University of South Carolina, Charleston.
Department of Pediatrics, Medical University of South Carolina, Charleston.
JAMA Pediatr. 2019 Nov 1;173(11):1041-1048. doi: 10.1001/jamapediatrics.2019.3073.
Telehealth may improve access to care for populations in rural communities. However, little is known about the effectiveness of telehealth programs designed for children.
To examine the associations of a school-based telehealth program in Williamsburg county (South Carolina) with all-cause emergency department (ED) visits made by children enrolled in Medicaid.
DESIGN, SETTING, AND PARTICIPANTS: This Medicaid claims data analysis was conducted in Williamsburg county and 4 surrounding counties in South Carolina and included children aged 3 to 17 years who were enrolled in Medicaid and living in any of the 5 counties from January 2012 to December 2017. Williamsburg served as the intervention and the 4 surrounding counties without a telehealth program as the control; 2012 to 2014 was designated as the preintervention period, whereas 2015 to 2017 served as the postintervention period. The study was designed with a difference-in-differences specification, in which the unit-of-analysis was a child-month, and a subsample included children with asthma. The data analysis was performed from July 2018 to February 2019.
The school-based telehealth program implemented in Williamsburg county in 2015.
The binary outcome was the status of at least 1 all-cause ED visit by a child in a given month.
The full sample included 2 443 405 child-months from 23 198 children in Williamsburg county and 213 164 children in the control counties. The mean (SD) proportions of monthly ED visits in Williamsburg were 3.65% (0.10%) during the preintervention and 3.87% (0.11%) during the postintervention. The corresponding proportions of the 4 control counties were 3.37% preintervention (0.04%), and 3.56% postintervention (0.04%), respectively. The trends in the proportion were paralleled. In the asthma subsample, the proportions in Williamsburg were 3.16% (0.31%) during the preintervention and 3.38% (0.34%) during the postintervention, respectively. The proportions for the control counties were 3.02% preintervention (0.10%) and 3.90% postintervention (0.11%), respectively. There was an interaction of the proportions between the pre/postintervention period and the intervention/control counties in this subsample. The regression analysis of the full sample showed no association of the telehealth program with ED visits. The additional analysis of the asthma subsample showed that this program was associated with a reduction of 0.66 (95% CI, -1.16 to -0.17; P < .01) percentage point per 100 children per month in ED visits, representing an approximately 21% relative decrease.
Although we found no association of this program with the ED visits of the overall studied population, this study suggests that telehealth with a focus on chronic pediatric diseases, such as asthma, may deliver substantial health benefits to rural and medically underserved communities.
远程医疗可能会改善农村社区人群获得医疗服务的机会。然而，对于为儿童设计的远程医疗项目的效果知之甚少。
研究南卡罗来纳州威廉斯堡县一项基于学校的远程医疗项目与医疗补助计划参保儿童的全因急诊就诊之间的关联。
设计、地点和参与者：这项医疗补助计划索赔数据分析在南卡罗来纳州的威廉斯堡县和周边4个县进行，纳入了2012年1月至2017年12月期间参加医疗补助计划且居住在这5个县中任何一个县的3至17岁儿童。威廉斯堡县作为干预地区，周边4个没有远程医疗项目的县作为对照；2012年至2014年被指定为干预前期，而2015年至2017年作为干预后期。该研究采用双重差分法设计，分析单位为儿童月，一个子样本包括哮喘患儿。数据分析于2018年7月至2019年2月进行。
2015年在威廉斯堡县实施的基于学校的远程医疗项目。
二元结局是给定月份内儿童至少一次全因急诊就诊的情况。
完整样本包括来自威廉斯堡县23198名儿童的2443405个儿童月以及对照县213164名儿童的数据。威廉斯堡县干预前期每月急诊就诊的平均（标准差）比例为3.65%（0.10%），干预后期为3.87%（0.11%）。4个对照县相应的比例在干预前期为3.37%（0.04%），干预后期为3.56%（0.04%）。比例趋势平行。在哮喘子样本中，威廉斯堡县干预前期的比例为3.16%（0.31%），干预后期为3.38%（0.34%）。对照县干预前期的比例为3.02%（0.10%），干预后期为3.09%（0.11%）。在这个子样本中，干预前期/后期与干预/对照县之间的比例存在交互作用。完整样本的回归分析显示远程医疗项目与急诊就诊无关联。哮喘子样本的进一步分析表明，该项目使每月每100名儿童的急诊就诊次数减少0.66个百分点（95%置信区间，-1.16至-0.17；P＜0.01），相对减少约21%。
尽管我们发现该项目与总体研究人群的急诊就诊无关联，但这项研究表明，专注于慢性儿科疾病（如哮喘）的远程医疗可能会给农村和医疗服务不足的社区带来显著的健康益处。
