Home-Based Telemedicine for Children with Medical Complexity

Patricia M Notario, Elise Gentile, Matthew Amidon, Denise Angst, Cheryl Lefaiver, Kathleen Webster, Patricia M Notario, Elise Gentile, Matthew Amidon, Denise Angst, Cheryl Lefaiver, Kathleen Webster

Abstract

Background: Children with medical complexity (CMC) are high utilizers of health care services. Telehealth encounters may provide a means to improve care outcomes for this population.Objective: To evaluate the feasibility, usability, and impact of an in-home telehealth device in the care of CMC.Methods: This single-center feasibility study employed a nonblinded randomized clinical trial design. English-speaking caregivers of children within a pediatric complex care program with home Wi-Fi were eligible for participation. Participants were randomized 1.5:1 with stratification based on tracheostomy status to a control group that received usual care or an intervention group that received a telehealth device for in-home use. Patients were followed up for 4 months. The primary outcome was successful device connectivity and data transmission. Data included clinician encounter device usability; caregiver satisfaction; and encounter type, purpose, and cost. Descriptive statistics, negative binomial regression, and Kaplan-Meier plot were used for analysis.Results: Twenty-four patients were enrolled (9 controls, 15 in the intervention group) in September 2016. The telehealth device was attempted in 73 encounters. Device connectivity was successful 96% of the time. Image and sound quality were acceptable in 98% of visits. Caregivers expressed their overall satisfaction with the device. The hospitalization rate was lower in the intervention group (0.77 vs. 1.14 intensive care unit days/patient-months), resulting in $9,425/USD per patient savings compared with the control group.Conclusion: Despite small sample size and short observation period, this study demonstrated that use of an in-home telehealth device is feasible, well received by caregivers, and can result in decreased hospitalizations when compared with usual care.

Trial registration: ClinicalTrials.gov NCT02849938.

Keywords: home health monitoring; pediatrics; telehealth; telemedicine.

Conflict of interest statement

No competing financial interests exist.

Figures

Fig. 1.
Fig. 1.
Tyto™ device setup and caregiver view. Image provided by TytoCare, Inc.
Fig. 2.
Fig. 2.
CONSORT diagram.
Fig. 3.
Fig. 3.
Kaplan–Meier survival analysis demonstrating time to first hospitalization by study group.

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Source: PubMed

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