Slide Presentation from the AHRQ 2007 Annual Conference

Results

• Visit completed = 96%
  Among the 1530 visits integration stage visits, 1474 (96%) had diagnosis and management decisions based entirely on telemed model
• Continuity of care with PC Practice = 87%
  • vs. continuity of care for RBCs = 0%
  • practice to practice variation 50%-93%
• 182 telemed visits/100 children/yr

Notes:

Among 1530 telemed visits attempted, 96%) were completed by 43 different clinicians. So telemed was effective in almost always giving clinicians everything they needed to know for clinical decision making.

Continuity averaged 87% among the 5 PC Practices. 87% continuity sounds pretty good, especially in light of survey results with parents of study children indicating that if they call their doctor in the afternoon about an illness, 75% are referred to an emergency department or after-hours clinic.

Continuity with practice at 87%, of course, is a lot better than the 0% continuity that is inherent with retail based clinics.

We're going to skip practice to practice variation in continuity for now.

The 587 participating children averaged 182 TM visits/100 children/yr. Based on national illness visit rates, this value of 182 is about half the expected annual illness visit rate for pre-school children. So it seems that this service is playing a major role in the healthcare of participating children.

[For the 13% of visits not seen by a continuity PC practice, the reason was because (1) the PC practice was unwilling to see the patient because the patient was covered by fee-for-service Medicaid (which would not reimburse), (2) the practice's telemed champion was not in the office when the telemed visit was requested and no other clinician in the office was able/willing to do the visit, or (3) the PC practice clinician felt he/she was too busy to accommodate the telemed visit within the available time frame (e.g., school was closing in 45 minutes).]