High-Intensity Telemedicine Reduces Emergency Department Use by Older Adults With Dementia in Senior Living Communities.

Objectives: Individuals with dementia have high rates of emergency department (ED) use for acute illnesses. We evaluated the effect of a high-intensity telemedicine program that delivers care for acute illnesses on ED use rates for individuals with dementia who reside in senior living communities (SLCs; independent and assisted living).

Design: We performed a secondary analysis of data for patients with dementia from a prospective cohort study over 3.

Taking Up the Challenge.

Proven capacity to enable both valid diagnostic decisions and effective management decisions should be required before health care innovations are adopted in routine practice. Various care models, although distinct in capacity for information acquisition and status of effectiveness and efficiency assessment, are marketed as telemedicine. Ability to meet criteria of effective and efficient decision making depends heavily on both the type of clinical problem at hand and the diagnostic and communication tools included in the telemedicine model.

Webside Manner: A Key to High-Quality Primary Care Telemedicine for All.

telemedicine

Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial.

Importance: Poor adherence to recommended preventive asthma medications is common, leading to preventable morbidity. We developed the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program to build on school-based supervised therapy programs by incorporating telemedicine at school to overcome barriers to preventive asthma care.

Objective: To evaluate the effect of the SB-TEAM program on asthma morbidity among urban children with persistent asthma.

Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr Robert Haggerty.

In the spirit of Dr. Haggerty's teachings, we present an overview of our work to improve care for children with asthma in the context of 3 lessons learned: 1) the importance of providing integrated services across disciplinary boundaries for children with chronic illness, 2) the need to move from a care model focused only on the individual child to a model focused on the child, family, and community, and 3) the need to expand beyond the local community and take a broad perspective on improving health on a national level. The goal of our program is to develop sustainable models to overcome the multiple obstacles to effective preventive care for urban children with asthma.

Urban Telemedicine Enables Equity in Access to Acute Illness Care.

Background: Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall.

Introduction: We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation.

Reducing Emergency Department Utilization Through Engagement in Telemedicine by Senior Living Communities.

Background: High-intensity telemedicine has been shown to reduce the need for emergency department (ED) care for older adult senior living community (SLC) residents with acute illnesses. We evaluated the effect of SLC engagement in the telemedicine program on ED use rates.

Materials And Methods: We performed a secondary analysis of data from a prospective cohort study evaluating the effectiveness of high-intensity telemedicine for SLC residents.

Care Offered by an Information-Rich Pediatric Acute Illness Connected Care Model.

Background And Objectives: Prevailing regulatory and financing issues constrain dissemination of connected care despite evidence supporting acceptability, effectiveness, and efficiency. In this analysis we describe care provided over a 12-year period by Health-e-Access, an evidence-based, information-rich, connected care model designed to serve children with acute illness. We demonstrate the broad clinical capacity of this care model and key components imparting this capacity.

Pursuit of Value in Connected Healthcare.

Introduction: Potential for direct patient care through remote exchange of health-related information has expanded enormously with the proliferation of technologies leveraging ubiquitous connectivity, but implementation of connected care has been slow and controversial.

Materials And Methods: This review demonstrates that controversy regarding connected care arises largely from the fact that proponents and critics are generally considering distinctly different care models. Differences are highlighted to mitigate controversy and to distinguish capacities of these different models.

Expanding Telemedicine to Include Primary Care for the Urban Adult.

This article describes the effective use of telemedicine for the urban adult patient. A successful pediatric telemedicine program was expanded to include care for adults. The pilot program resulted in high levels of patient satisfaction, decreased loss of work time, and decrease in inappropriate use of the emergency department.

High-Intensity Telemedicine Decreases Emergency Department Use for Ambulatory Care Sensitive Conditions by Older Adult Senior Living Community Residents.

Background: Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) are common among older adults. The high-intensity telemedicine model of care has been proposed as an innovative approach to expand access to acute illness care, thereby preventing ED visits. The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of ED use for ACSCs.

High-Intensity Telemedicine Decreases Emergency Department Use by Senior Living Community Residents.

Background: The failure to provide timely acute illness care can lead to adverse consequences or emergency department (ED) use. We evaluated the effect on ED use of a high-intensity telemedicine program that provides acute illness care for senior living community (SLC) residents.

Materials And Methods: We performed a prospective cohort study over 3.

Effectiveness and Safety of Acute Care Telemedicine for Children with Regular and Special Healthcare Needs.

Objective: 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).

Materials And Methods: We examined healthcare use through insurance claims and telemedicine records spanning 5.7 and 7.

Caregiver Preferences Regarding Personal Health Records in the Management of ADHD.

Objective: Personal health records (PHRs) may address the needs of children with attention deficit hyperactivity disorder. Among parents, we assessed acceptance, barriers, and intentions regarding use of PHR for their children with attention deficit hyperactivity disorder.

Methods: Survey of parents from 3 practices in Rochester, NY.

Patient evaluation of an acute care pediatric telemedicine service in urban neighborhoods.

Background: Telemedicine has enhanced care for children with illness in Rochester, NY, since May 2001, enabling 13,568 acute illness visits through December 2013. Prior findings included high parent satisfaction with childcare- and school-based telemedicine ("school telemedicine") and potential to replace 85% of office visits for illness. Urban neighborhood telemedicine ("neighborhood telemedicine") was designed to offer convenient care for illness episodes that school telemedicine often cannot serve because illness arises when children are at home or symptoms preclude attendance.

High-intensity telemedicine-enhanced acute care for older adults: an innovative healthcare delivery model.

Accessing timely acute medical care is a challenge for older adults. This article describes an innovative healthcare model that uses high-intensity telemedicine services to provide rapid acute care for older adults without requiring them to leave their senior living community (SLC) residences. This program, based in a primary care geriatrics practice that cares for SLC residents, is designed to offer acute care through telemedicine for complaints that are felt to need attention before the next available outpatient visit but not to require emergency department (ED) resources.

A qualitative evaluation of a telemedicine-enhanced emergency care program for older adults.

Objectives: To document the experiences of patients, their caregivers, healthcare personnel, and staff members with a program that provides telemedicine-enhanced emergency care to older adults residing in senior living communities (SLCs) and to delineate perceived barriers and facilitators.

Design: Qualitative study.

Setting: A primary care geriatric medicine practice.

Telemedicine in urban and suburban childcare and elementary schools lightens family burdens.

Background: Acute illness challenges all families with young children. The Health-e-Access Telemedicine Network in Rochester, NY, has enabled >7,000 telemedicine visits since 2001 among children in childcare or elementary schools, predominantly from Rochester's inner city. Large reductions in illness-related absence and emergency department use among Health-e-Access participants have occurred.

Integrating telemedicine in urban pediatric primary care: provider perspectives and performance.

Background: Health-e-Access, an urban telemedicine service, enabled 6,511 acute-illness telemedicine visits over a 7-year period for children at 22 childcare and school sites in Rochester, NY.

Objectives: The aims of this article were to (1) describe provider attitudes and perceptions about efficiency and effectiveness of Health-e-Access and (2) assess hypotheses that (a) providers will complete a large proportion of the telemedicine visits attempted and (b) high levels of continuity with the primary care practice will be achieved.

Design/methods: This descriptive study focused on the 24-month Primary Care Phase in the development of Health-e-Access, initiated by the participation of 10 primary care practices.

Acute illness care patterns change with use of telemedicine.

Objective: Health-e-Access, a telemedicine service providing care for acute illnesses in children, has delivered >6500 telemedicine visits from 10 primary care practices in Rochester, New York, by using telemedicine access at 22 child care and school sites. The goal was to assess the hypotheses that children served by Health-e-Access received health care more often for acute illnesses but had fewer emergency department (ED) visits and lower health care expenditures than did children without access through this service.

Methods: By using insurance claims, this case study compared utilization (starting in May 2001) of telemedicine, office, or ED care for children with versus without telemedicine access.

Acute illness utilization patterns before and after telemedicine in childcare for inner-city children: a cohort study.

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.

Dental screening of preschool children using teledentistry: a feasibility study.

Purpose: The purpose of this study was to assess the feasibility and reliability of using intraoral cameras and telehealth communication technology to screen preschool children for oral disease, in particular early childhood caries (ECC).

Methods: The authors used the existing infrastructure of the Health-e-Access telehealth Network to: (1) assess the diagnostic quality of dental images using the Dr. Camscope intraoral camera; and (2) compare the resulting images to a traditional oral examination.