Telemedicine and e-Health最新文献

Background: The exponential growth in the use of telehealth during the pandemic underscored the need to quantify how telehealth impacts overall health care costs. While the pandemic inhibited access to in-person care for all Americans, access to care will remain challenging for some populations. Objective: We sought to assess the cost-benefit of telehealth by reviewing a data set of 1.4 million telehealth encounters across the United States performed between February and September 2020. Methods: A retrospective analysis used data from six large health systems and one state Medicaid agency. The economic model considered both direct and indirect costs. Results: Building upon a report published in 2021 by the Centers for Telehealth and eHealth Law, this article presents an analysis of the six states with the highest telehealth encounters within the data set. The study revealed significant cost savings. Telehealth was associated with a reduction in costs ranging from $445,000 to $33 million for Medicare and $155,000-$181 million for Medicaid, except for one metropolitan area. Cost savings were based on the most frequent diagnoses: behavioral health, cancer, heart disease, pulmonary conditions, and endocrine disorders. Limitations: The use of encounter data prohibited the analysis of a patient's longitudinal use of telehealth. Each encounter was treated as a unique observation. While the data set represented telehealth use across the nation, some states were over-represented while others were under-represented, based on available data. Finally, for the six health systems, data was restricted to the regions covered by the health system. As such, in some states, most encounters take place in metropolitan areas. Conclusion: Telehealth can generate significant cost savings, particularly within the Medicaid program, by increasing access to health care452244 services, especially for conditions directly impacted by provider shortages within geographic proximity to the patient.

Background: Since the COVID-19 pandemic, telehealth has been widely adopted, and several studies have highlighted the benefits of telehealth. However, there are limited studies in pediatric neurology with a focus on epilepsy. The objective of this single-site retrospective cohort study was to examine patient experience scores of telehealth versus in-person established encounters in an outpatient pediatric neurology clinic. Methods: Data were abstracted from April 1, 2020 through March 31, 2024. Variables included demographics, appointment type (telehealth vs in-person), appointment date, primary diagnosis and net promoter score (NPS) number and category. A subanalysis of epilepsy diagnosed patients, and a matched patient analysis were conducted. Results: There were 2,863 in-person visit encounters and 635 telehealth visit encounters. Telehealth encounters had a statistically greater mean NPS of 9.7, compared with in-person visits (9.5). Both telehealth and in-person encounters had more than 90% of promoter scores, indicating a high score of 9-10. During the COVID-19 time period (defined as April 1, 2020 to May 4, 2023), NPS were higher with a mean of 9.7 for telehealth encounters, compared with in-person encounters (9.5). There were no differences in NPS post-COVID-19. Primary encounter diagnoses of Epilepsy/Seizure had a slightly greater mean NPS for telehealth visits (9.7) compared with in-person encounters (9.5). The matched patient analysis revealed no difference between telehealth and in-person encounter NPSs with means of 9.7 and 9.6, respectively. Conclusion: NPS, which are a measure of patient experience, were superior or equal to in-person visits for pediatric neurology telehealth encounters both during the COVID-19 pandemic and in the postpandemic period.

Background: This study evaluates the impact of temporary telemedicine implementation on primary care visits, which surged during the COVID-19 pandemic in South Korea. Methods: This study was conducted using national claims data from February 24, 2020 to February 23, 2021. The study included 1,926,300 patients with acute mild respiratory diseases and 1,031,174 patients with acute mild gastrointestinal diseases. The study compared medication prescriptions, follow-up visit patterns, and safety outcomes, including admissions to emergency departments (EDs), general wards (GWs), and intensive care units (ICUs), between telemedicine and in-person visits. Results: Telemedicine was linked to higher medication prescription rates for both respiratory and gastrointestinal conditions, higher levels of antibiotics use, and longer prescription durations. Patients who had an initial telemedicine consultation were more likely to have an in-person follow-up visit within 1 day. Conversely, those with an initial in-person visit were more inclined to use telemedicine for their early second visit within 1 day. There were no significant differences in ED or ICU admissions, except for a slight increase in GW admissions for gastrointestinal conditions. Conclusion: Telemedicine can effectively complement in-person care for acute mild conditions without compromising patient safety, suggesting its potential for broader integration into primary care. Further studies are recommended to optimize telemedicine use and address any long-term impacts on health care delivery.

Introduction: The COVID-19 pandemic necessitated swift, dramatic changes to the delivery of essential health care services. Numerous professional societies recommend telehealth care for contraceptive counseling and provision. We conducted a retrospective analysis of service delivery data from Planned Parenthood of Illinois (PPIL), a large reproductive health care provider with 17 health centers in Illinois, to understand if this model preserved access to contraceptive services during the COVID-19 emergency. Methodology: This retrospective analysis compared contraceptive service delivery data 12 months pre-pandemic (March 2019-February 2020) with eight months post-pandemic onset (March 2020-October 2020). PPIL consolidated services to six health centers in late March 2020 and rapidly launched telehealth services in April 2020. Our primary outcome was time to appointment compared with pre- and post-pandemic onset. We also compared access by race/ethnicity, age, and geography. Results: Although visit volume decreased (76% decline) and time to appointment increased post-pandemic onset (2.5-4 days higher), telehealth mitigated these changes and was used by patients across the entire catchment area. We observed no disparities among Black and Hispanic patients relative to White patients in the likelihood of using telehealth relative to in-person visits (odds ratio 0.7, 95% confidence interval 0.6-0.9 for both comparisons). Discussion: Telehealth can play an important role in preserving access to contraceptive services when the health care system is under strain and in increasing accessibility in underserved communities.

Introduction: Rural hospitals continue to close nationally. High fixed costs, low patient volume, and outmigration remain problematic for surviving rural hospitals. This article presents an innovative telemedicine partnership between a small, not-for-profit rural hospital and a tertiary care medical center in the southeast. The vision was to create a sustainable care delivery model where patients receive care at a rural hospital in their home community with the added benefit of clinical expertise from a tertiary care center. Methods: A single-center descriptive case study involving a 32-bed not-for-profit rural community hospital and South Carolina's only comprehensive medical center. This article details the development and implementation of this innovative care delivery model. The strategy and logic model utilized to analyze the program is described. Results: From fiscal year 2019 to 2022, Hampton Regional Medical Center saw an increased number of yearly admissions from 442 to 965. Associated, there was a 20% reduction in inpatient transfers to another facility and a 35% reduction in 30-day readmission, while seeing a more complex patient population as demonstrated by an increase in case-mix index. There was no increase in outmigration. Conclusions: While rural hospitals continue to close nationally, we describe an innovative telemedicine partnership between a small, not-for-profit rural hospital and a tertiary care medical center to build a sustainable care delivery model that can support rural hospital survivability.

Background: Unmet social needs may hinder health care providers' ability to deliver suitable care. Telehealth has emerged as a mechanism to broaden care reach; however, limited studies have examined the relationships between telehealth services and social need outcomes. This study explores the impact of telehealth services, encompassing (1) telestroke, (2) telepsychiatry and addiction treatment, (3) teleconsultation and office visits,(4) tele-intensive care units, (5) telemonitoring postdischarge, (6) ongoing chronic care management, and (7) other remote monitoring, on social need performance outcomes. Methods: The 2022 American Hospital Association annual survey and the Area Health Resource Files, which include comprehensive hospital and community indicators, were utilized. A mixed-effects logistic regression was applied, analyzing 1,005 acute care general hospitals. Results: The results revealed that patients who received telemonitoring services after discharge were 1.72 (95% confidence interval [CI]: 1.03-2.88) times more likely to achieve better health outcomes compared with those who did not receive such services. These patients also experienced a significant decrease in the likelihood of requiring additional hospital or system services, with an odds ratio of 2.39 (95% CI: 1.32-4.00). Additionally, patients utilizing telepsychiatry and addiction treatment services had 1.66 times higher odds of reporting improved community health status (95% CI: 1.22-2.27). Lastly, patients who used teleconsultation and office visit services had 38% lower odds of experiencing poor community health status (95% CI: 0.40-0.95). Discussion: The findings highlight the potential of targeted telehealth services to positively impact health outcomes, reduce health care costs, and improve community health status.

Introduction: Elite athletes experience sport-specific stressors and are at risk of developing mental health symptoms during and after their careers. E-Mental health interventions may pioneer a new approach to health care, which could help overcome barriers regarding its accessibility for elite athletes. This study aims to examine the needs and demands regarding the design and content of e-mental health interventions for elite athletes. Methods: A cross-sectional study was conducted via a web-based survey with N = 275 elite athletes, of which 167 were female and who participated in a variety of individual and/or team sports. Previous experience using e-mental health interventions was assessed. Needs and demands regarding format, frequency, content, and topics of an e-mental health intervention were analyzed descriptively and were compared between individual and team athletes using ANOVAs. Results: Elite athletes expressed a preference for an individual program via smartphone app (94.2%) with audio/video material (69.1%) and interactive tasks (60.4%). Regarding the frequency of e-mental health intervention, athletes in individual (62.2%) and team sports (60.0%) both preferred weekly intervention with sessions lasting between 20 and 30 min, whereas athletes engaged in both kinds of sports favored an intervention either on a weekly basis (44.7%) or on request (38.3%). The most relevant topics of e-mental health interventions for elite athletes were "Coping with pressure" (92%) and "Self-worth/self-esteem" (90%). Conclusions: The results of this study highlight the potential relevance of a user-centered design approach and could contribute valuable insights into developing e-mental health interventions for elite athletes.

Purposes: This study aims to use bibliometric analysis to explore the development, research hotspots, and trends in the field of telemedicine for surgical practices (TSPs). Methods: A bibliometric analysis of 3,235 documents from the Web of Science Core Collection was conducted, spanning from 2004 to 2022. Citespace (6.2.R5) was used to perform a bibliometric analysis. Results: The findings highlight a marked escalation in researches of TSPs, particularly between 2019 and 2022, aligning with the COVID-19 pandemic. The Telemedicine and e-Health Journal was the most productive journal with 118 publications, and Journal of Telemedicine and Telecare had the most citations (n = 700). Howard S. An and Mohammad El-sharkawi had the most papers (n = 8). Harvard University was the most prolific institution (n = 103). The United States, England, and Canada were identified as the predominant contributing countries with a total of 1,521 publications. There was a notable shift in research focus areas over time, with recent emphasis being placed on pediatric surgery, COVID-19-related studies, and orthopedics. Future trends may involve teleconsulting, ameliorating the quality and safety of telemedicine, and improving satisfaction levels of patients and caregivers when they are using telemedicine. Conclusions: The study reveals that the rapid and sustained advancement in TSPs, significantly driven by the COVID-19 pandemic, and huge gaps between developed countries and developing countries. This study also reflects the current hotspots and future directions for TSPs.

Background: Telehealth can provide innovative models of care for people living in congregate care communities (CCC), but lack of consistent workflow is a barrier for administrators and staff. We propose a framework for CCC to implement workflows for age-inclusive telehealth. Methods: As part of an infection control initiative with a focus on telehealth optimization, Virginia Infection Mitigation, Prevention and Control Through Technology developed relationships with administrators and staff of CCC across the Commonwealth of Virginia. Partners in this community of practice completed a statewide survey that we conducted on anticipated and experienced barriers to telehealth implementation. Through survey responses, virtual meetings with organizational leadership, and on-site facility visits, our team assessed the strengths, needs, and goals for telehealth capability. Working with administrative and clinical teams, we developed a consultation report to define short- and long-term implementation steps. Results: We collaborated with a nonprofit organization supporting a community of people with neurodevelopmental disabilities and a rural Program of All-Inclusive Care for the Elderly. We developed a framework for telehealth optimization with four tiers: Initiate, Integrate, Incentivize, and Inspire. Each stage included an overall goal with corresponding interventions to guide program implementation. Discussion: The "Four I" Framework can be used to outline telehealth readiness and implement workflows for CCC. We aim to further develop an iterative process and to collaborate with additional organizations to optimize telehealth programs.