- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04981002
Telemedicine and Face-to-face Consultations Diagnostic Accuracy Comparison in Orthopedic Patients
Analysis of the Accuracy of Telemedicine-guided Orthopedic Self-examination Compared to Face-to-face Assessment in an Emergency Care Unit: a Randomized Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Randomized, prospective, single-center study carried out in the telemedicine sectors and emergency care unit of Hospital Israelita Albert Einstein, Ibirapuera Unit. The randomization will be 1:1, from the commercial application Randomizer ®, by the member of the project Renata Vidigal Correia.
After randomization, patients will be included in one of two possible groups:
- TELE Group: first care will be provided via telemedicine with a clinical physician, guiding self-examination guided by telemedicine. After the remote consultation, a face-to-face evaluation will be carried out with an orthopedist, according to institutional protocol.
- GrupoSTANDARD: Face-to-face care with an orthopedist, according to institutional protocol.
The face-to-face evaluation will be carried out by the local UPA medical and orthopedic care team and the telemedicine evaluation by the fixed medical team of the HIAE service responsible for urgency/emergency care.
The study will be of non-inferiority with evaluation of accuracy in both groups, since the telemedicine group, after completion of care, will pass the face-to-face consultation (gold standard).
Both in face-to-face and telemedicine assessments, clinical data, final diagnosis, destination, total time of care, guidance, complementary exams and prescription will be computed. In the face-to-face evaluation, additional exams and medications received in situ will also be computed. The final diagnoses will receive nomenclature according to the International Statistical Classification of Diseases and Related Health Problems - ICD 10 (requirement of institutional records - Cerner) and will be grouped according to the equivalence of the syndromic diagnosis. The diagnosis of the face-to-face evaluation is made following institutional protocols based on extensive medical literature and approved by the institutional clinical staff, being representative of current medical practice and will be considered the gold standard diagnosis.
The total service time in minutes will be evaluated, verifying if telemedicine can change the total medical service time. The fee for complementary exams will be counted in the number of exams requested and their categorization (laboratory exam or imaging exam); the quantification in number and its categorization (behavioral measures, cryotherapy guidelines and new medical evaluation if necessary) of the guidelines; categorization of prescription (only symptomatic or medication in the UPA); destination categorization (high - item valid for both services, hospitalization - valid item for face-to-face care, search for the ER - valid item for telemedicine care), hospital cost (measured by the need for immobilization/complementary tests), and indication of additional tests .
The final diagnosis will be considered by the official report of the radiologist based on the imaging exams performed.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Noel Oizerovici Foni, MD
- Phone Number: +55 11 99697-0529
- Email: noel.foni@einstein.br
Study Locations
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-
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São Paulo, Brazil
- Recruiting
- Hospital Israelita Abert Einstein
-
Contact:
- Noel Foni
-
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age > 18 years;
- Patient with orthopedic complaints according to the above diagnostic criteria, by the triage nurse.
- Signing the informed consent form.
Exclusion Criteria:
- Return to the UPA for maintenance or aggravation of the complaint;
- Age > 65 years;
- Patient with emergency room criteria by the evaluation of the triage nursing.
- Postoperative period of orthopedic surgery < 3 months
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Adult patients with orthopedic complaints - telemedicine self exam before face-to-face evaluation
First care will be performed via telemedicine with a clinical physician, guiding self-examination guided by telemedicine.
After the remote consultation, a face-to-face evaluation will be performed with an orthopedist, according to institutional protocol.
|
Direct face-to-face evaluation (without telemedicine consultation before).
Brief telemedicine consultation, with self orthopedic exam,blinded to subsequent face-to-face evaluation.
|
Active Comparator: Adult patients with orthopedic complaints - only face-to-face evaluation
Face-to-face care with an orthopedist, according to institutional protocol.
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Direct face-to-face evaluation (without telemedicine consultation before).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Accuracy of telemedicine diagnosis in adult patients with orthopedic complaints
Time Frame: through study completion, an average of 1 year
|
The patient will be evaluated by telemedicine and / or face-to-face consultation and at the end will receive the diagnosis, which will be assigned the ICD code for orthopedic complaints.
At the end, these ICDs will be grouped by the same clinical significance (M54: Neck pain and Low back pain; T11-T13: Extremity contusion; S93: Ankle Sprain) and will be compared between the two consultation methods (telemedicine versus face-to-face consultation).
|
through study completion, an average of 1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time of medical care
Time Frame: through study completion, an average of 1 year
|
Comparison of time (minutes) of medical care between telemedicine and face-to-face consultation.
|
through study completion, an average of 1 year
|
Rate of indication for complementary exams
Time Frame: through study completion, an average of 1 year
|
Comparison of rate (percentage) of indication for complementary exams between telemedicine and face-to-face consultation.
|
through study completion, an average of 1 year
|
Types of requested exams
Time Frame: through study completion, an average of 1 year
|
Comparison of types of requested exams (percentage) between telemedicine and face-to-face consultation.
|
through study completion, an average of 1 year
|
Medical prescription
Time Frame: through study completion, an average of 1 year
|
Comparison of medical prescription after completion of the service between telemedicine and face-to-face consultation.
|
through study completion, an average of 1 year
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Proposed destination after completion of the service
Time Frame: through study completion, an average of 1 year
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Comparison of proposed destination (percentage of discharge or hospitalization) after completion of the service between telemedicine and face-to-face consultation.
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through study completion, an average of 1 year
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Total hospital cost after completion of care
Time Frame: through study completion, an average of 1 year
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Comparison of total hospital cost after completion of care (Real and Dollar) between telemedicine and face-to-face consultation.
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through study completion, an average of 1 year
|
Patient satisfaction
Time Frame: through study completion, an average of 1 year
|
Comparison of patient satisfaction (percentage) between telemedicine and face-to-face consultation.
|
through study completion, an average of 1 year
|
Collaborators and Investigators
Investigators
- Principal Investigator: Noel HS Oizerovici Foni, MD, Telemedicine Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- 46603821.9.0000.0071
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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