Using Telehealth to Care for Children with Medical Complexity

Category/Date Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Pediatric Research: Chronic Illness, Presented at NAPNAP's 40th National Conference on Pediatric Health Care, March 8, 2019, New Orleans, LA. Background Children with medical complexity (CMC) are high utilizers of health care services. Cost and logistics of transportation may result in delays in seeking care, or seeking care after hours in an emergency department (ED). Telehealth encounters may provide an important means to address unmet health needs, prevent ED and hospital visits, reduce costs, and improve care outcomes for CMC. A pediatric nurse practitioner (PNP) is well-situated to use technology to help families meet goals of keeping their child at home. Objectives The purpose of the study was to evaluate the role of a PNP in use of a telehealth device in the care of CMC within an established pediatric complex care program. Specific aims were to assess the feasibility of telehealth in the home environment; evaluate its usability in transmitting real time data; and compare its impact on patient management. Methods This IRB approved, industry sponsored pilot study was conducted at a single center and employed a randomized clinical trial design. Participants were randomized 1.5:1 with stratification based on tracheostomy status to either a control group that received usual care or an intervention group that was given a telehealth device for use in the home at the discretion of a provider. All subjects were followed for 4 months (1 technical month, 3 study months) and had 24/7 access to the program providers, which included a PNP and a physician. Data collected included provider encounter surveys; family satisfaction surveys; and resource utilization type, purpose, and outcomes. Results Twenty-four patients were enrolled in the study: 9 controls,15 in the intervention group. In the intervention group, telehealth visits were attempted in 73 encounters. Providers reported successful device connectivity 92% of the time. Provider surveys indicated that the majority of encounters focused on respiratory/ENT complaints (66.7%). Based on provider survey results, usability for all device peripherals was acceptable (>90%), except for the otoscope (59%), which was related to patient refusal or parental discomfort. Families and providers expressed overall satisfaction with the device. Device use resulted in management changes such as close follow up by the PNP at home for a ventilated patient with a respiratory illness. Hospitalization rate decreased in the intervention group as compared to the control group (0.77 versus 1.14 PICU days/patient-month). Calculated cost rates (direct cost of encounter multiplied by the visit rate) showed a $44,751.65 ($9,425 per patient) cost savings for the intervention group. Conclusions Despite a small sample size and short study period, this pilot study demonstrated the feasibility of a PNP led telehealth program and that use of the telehealth device showed an overall benefit not only improving patient related outcomes but reducing cost of care. This study provides a foundation for examining the value of telehealth in the homes of other populations with special health care needs.