Evaluating the Role of Telehealth in the Care of Children with Medical Complexity: A Randomized Pilot Study
Patricia M Notario, MD, Matthew Amidon, DO, Elise Gentile, MS, APN, CPNP-PC, Denise Angst, PhD, RN, Cheryl Lefaiver, PhD, RN, Kathleen Webster, MD, MBA. Advocate Children’s Hospital, Oak Lawn, IL
Children with medical complexity (CMC) are high utilizers of health care services. Telehealth encounters may provide an important means to address unmet health needs, prevent ED and hospital visits, and improve care outcomes for CMC.
The purpose of the study was to evaluate the 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; evaluate its usability in transmitting real time data; and compare its impact on patient management.
This IRB approved, single center, industry sponsored pilot study employed a non-blinded randomized clinical trial design (ClinicalTrials.gov #NCT02849938). English speaking caregivers of patients enrolled in a complex care program with Wi-Fi in the home were eligible for the study. 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). Primary outcome was device success in connectivity and ability to transmit remote exam findings. Data collected included provider encounter surveys; family satisfaction surveys; and healthcare encounter type, purpose, cost and outcomes. Tyto Care provided in-kind commercial support such as tablets, devices and Wi-Fi connectivity for some patients.
Twenty-four patients were enrolled (9 controls, 15 intervention group) for study from September 2016 to January 2017. Data from all patients were analyzed in the group to which they were randomized. The telehealth device was used for 46 encounters. Device connectivity was successful 92% of the time. Providers reported acceptable usability for device peripherals 90% of the time, except for the otoscope (64%). Families and providers expressed overall satisfaction with the device. Hospitalization rate was less in the intervention group (0.62 versus 1.14 PICU days/patient-months), resulting in $7184 savings as compared to the control group.
Despite a small sample size and short study period, this study demonstrated that telehealth exams by the family in the home is feasible and showed an overall benefit in decreasing resource utilization and reducing cost of care.