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Levy BE, Wilt WS, Johnson J, Wallace H, Ballert E, Newcomb M, Cavatassi W, Harris A. Procedure-Based Telehealth Utilization in General Surgery. Am J Med Qual 2023; 38:154-159. [PMID: 37125671 DOI: 10.1097/jmq.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors hypothesize that standardized telehealth (TH) scheduling processes will improve TH utilization without increasing adverse events. Fifty visits preimplementation and 67 visits postimplementation were audited from June 2021 to January 2022. Both leadership and frontline stakeholders were engaged to identify current workflows and potential interventions targeting outpatient elective procedures. Process mapping outlined current TH scheduling workflows. Outcomes related to TH completion, cost, and TH scheduling were collected after implementation. Preimplementation TH scheduling rate was 32%. The intervention required TH postoperative appointments to be scheduled in clinic at the time of surgery scheduling with TH being the default postsurgical appointment for a standardized list of eligible procedures. Following implementation, 95% of patients undergoing eligible procedures had TH follow-up. This provided improved access to surgical follow-up care, by reducing travel needs to the Veterans Affairs facility. Secondarily, this intervention increased clinic appointment availability and resulted in possible increased revenue for billable visits. Standardizing TH scheduling based on the procedure improves the utilization of TH resulting in improved clinic efficiency and increased revenue, without increasing adverse events.
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Affiliation(s)
- Brittany E Levy
- Department of General Surgery, University of Kentucky, Lexington, KY
| | - Wesley S Wilt
- Department of General Surgery, University of Kentucky, Lexington, KY
| | | | | | - Erik Ballert
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Melissa Newcomb
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - William Cavatassi
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Andrew Harris
- Lexington Veteran's Affairs Medical Center, Lexington, KY
- Department of Urology, University of Kentucky, Lexington, KY
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Maimela G, Nene X, Mvundla N, Sawry S, Smith T, Rees H, Kachingwe E, Chersich M. The impact of decentralising colposcopy services from tertiary-level to primary-level care in inner-city Johannesburg, South Africa: a before and after study. BMJ Open 2019; 9:e024726. [PMID: 30928936 PMCID: PMC6475219 DOI: 10.1136/bmjopen-2018-024726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess whether decentralising colposcopy services to a primary care facility in inner-city Johannesburg, South Africa raises access to colposcopy. DESIGN Before-after study comparing 2 years before and 2 years after decentralisation, using clinical records and laboratory data on cervical cytology and histology. PRIMARY OUTCOME The proportion of all women attending Hillbrow Community Health Centre (HCHC) with an abnormal Papanikolaou (Pap) smear who had a colposcopy post-decentralisation. SETTING Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) has provided colposcopy services for several decades. HCHC, located about 3 km away, began colposcopy services in 2014. PARTICIPANTS Women, aged above 18 years, who had a colposcopy for diagnosis and treatment of precancerous cervical lesions following a Pap smear, from 2012 to 2016 at CMJAH or HCHC. RESULTS Pre-decentralisation at CMJAH, 910 women had colposcopy (2012-2014). Post-decentralisation (2014-2016), 721 had colposcopy at CMJAH and 399 at HCHC, the decentralised facility. The number who had a Pap smear at HCHC and then a colposcopy rose threefold post-decentralisation (114 vs 350). Post-decentralisation, 43 women at HCHC were referred to CMJAH for colposcopy, compared with 114 pre-decentralisation. Post-decentralisation, 47.3% of women at CMJAH waited >6 months for colposcopy, while 35.5% did at HCHC (p<0.001). Across all three groups, 26.9%-30.3% of women had cervical intraepithelial neoplasia III lesions or carcinoma on colposcopy. The proportion of invalid specimens was similar at CMJAH and HCHC (1.8%-2.8%). Of 401 women who had an abnormal Pap smear at HCHC post-decentralisation, 267 had colposcopy (66.6%). CONCLUSION Decentralisation can decrease the time to colposcopy and reduce the workload of tertiary hospitals. Overall, more women accessed services. Colposcopy coverage at HCHC is higher than other sites, but could be further improved. Decentralisation did not appear to undermine the quality of services and this model could be extended to similar settings in South Africa and elsewhere.
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Affiliation(s)
- Gloria Maimela
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Xolisile Nene
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Nontuthuko Mvundla
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Trudy Smith
- Wits Donald Gordon Medical Centre, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Gauteng, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elizabeth Kachingwe
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Hitt WC, Low GM, Lynch CE, Gauss CH, Magann EF, Lowery CL, Eswaran H. Application of a Telecolposcopy Program in Rural Settings. Telemed J E Health 2016; 22:816-820. [PMID: 27128600 DOI: 10.1089/tmj.2015.0260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Individuals in rural areas are often restricted by the amount of physicians' availability, thus limiting access to healthcare in those settings. INTRODUCTION While Pap smear screening has increased across the United States, the rural South still reports high rates of cervical cancer and mortality. One solution to improve patient outcomes related to cervical cancer in rural settings is telecolposcopy. MATERIALS AND METHODS Women with abnormal Pap results or an abnormal visual examination needing an evaluation by colposcopy were referred to a hospital-based telecolposcopy program. Descriptive data are provided that include patients' access to care based on travel time and transportation costs. RESULTS Over a 15-month time period, 940 unique patients were seen using telecolposcopy. Telecolposcopy was done at eight spoke sites across Arkansas representing patients from 72 of the 75 counties. Data for risk factors that include smoking, first sexual experience, and number of sexual partners in past 12 months and in a lifetime are discussed. Pap results and impression are provided. In addition, avoided transportation costs and travel time have been calculated and included. DISCUSSION Cervical cancer is important public health concern especially for women residing in rural areas. We were able to demonstrate that our telecolposcopy program has provided sustainability statewide since its inception and that patients are willing to participate. In addition to providing increased access to care, the program also reduced travel time and costs associated with a face-to-face visit. CONCLUSION Telecolposcopy should be further explored and utilized in rural settings as a way to reduce patient costs and improve cervical cancer outcomes.
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Affiliation(s)
- Wilbur C Hitt
- 1 Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Gordon M Low
- 1 Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Christian E Lynch
- 1 Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - C Heath Gauss
- 2 Department of Biostatistics, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Everett F Magann
- 1 Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Curtis L Lowery
- 1 Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Hari Eswaran
- 1 Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
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Wade VA, Karnon J, Elshaug AG, Hiller JE. A systematic review of economic analyses of telehealth services using real time video communication. BMC Health Serv Res 2010; 10:233. [PMID: 20696073 PMCID: PMC2927589 DOI: 10.1186/1472-6963-10-233] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 08/10/2010] [Indexed: 12/15/2022] Open
Abstract
Background Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area. Methods A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded. Results 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study. Conclusion Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care.
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Affiliation(s)
- Victoria A Wade
- Discipline of Public Health, The University of Adelaide, North Tce, Adelaide 5005, Australia.
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Dávalos ME, French MT, Burdick AE, Simmons SC. Economic Evaluation of Telemedicine: Review of the Literature and Research Guidelines for Benefit–Cost Analysis. Telemed J E Health 2009; 15:933-48. [DOI: 10.1089/tmj.2009.0067] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- María E. Dávalos
- Health Economics Research Group, Department of Sociology, University of Miami, Coral Gables, Florida
| | - Michael T. French
- Health Economics Research Group, Department of Sociology, Department of Economics, and Department of Epidemiology and Public Health, University of Miami, Coral Gables, Florida
| | - Anne E. Burdick
- TeleHealth Department, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Scott C. Simmons
- TeleHealth Department, Miller School of Medicine, University of Miami, Miami, Florida
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Alverson DC, Holtz B, D'Iorio J, DeVany M, Simmons S, Poropatich RK. One size doesn't fit all: bringing telehealth services to special populations. Telemed J E Health 2009; 14:957-63. [PMID: 19035807 DOI: 10.1089/tmj.2008.0115] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Telehealth applications and information communication technologies can be customized and scaled to meet the healthcare service needs of a wide variety of special populations. Categorization of those special groups can be viewed from a spectrum of perspectives such as by gender, age, culture, families, communities, chronic conditions, or particular types of locations, as well as when addressing a specific or unique health need. The emergence of innovations in the use of a range of technologies and connectivity offers exciting new approaches to the integration of telehealth aimed at improving quality and continuity of care to better meet the needs of special populations.
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Affiliation(s)
- Dale C Alverson
- Center for Telehealth and Cybermedicine Research, University of New Mexico, Albuquerque, New Mexico 87106, USA.
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Cronquist Christensen M, Remler D. Information and communications technology in chronic disease care: what are the implications for payment? Med Care Res Rev 2007; 64:123-47. [PMID: 17406017 DOI: 10.1177/1077558706298288] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
New information and communication technology (ICT) has the potential to improve care for chronic conditions, deliver better health outcomes, and reduce direct and indirect costs. However, realizing these gains necessitates new forms of care delivery, through adoption of ICT, the specific choice of ICT, and changes to existing forms of health care delivery. Realizing these new forms of delivery requires appropriate payment policies. The authors review the literatures on health care payment and ICT in chronic care and then apply theoretical economic analysis to determine how ICT alters health care payment policy recommendations. Using diabetes as an example, the authors identify and illustrate the disease and technology features that determine the optimal form of payment. Overall, ICT shifts the optimal blend of fee-for-service and capitation toward greater capitation. Carve-outs for ICT-supported preventive care enable more high-powered payment while addressing selection concerns.
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Liu X, Sawada Y, Takizawa T, Sato H, Sato M, Sakamoto H, Utsugi T, Sato K, Sumino H, Okamura S, Sakamaki T. Doctor-patient communication: a comparison between telemedicine consultation and face-to-face consultation. Intern Med 2007; 46:227-32. [PMID: 17329917 DOI: 10.2169/internalmedicine.46.1813] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. METHOD Five doctors who had been practicing internal medicine for 8 to 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures--video observation, medical record volume, and participants' satisfaction--were used for the assessment. RESULTS It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathy-utterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. CONCLUSIONS This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.
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Affiliation(s)
- Xiao Liu
- Medical Informatics and Decision Sciences, Gunma University Graduate School of Medicine, Maebashi, Japan
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Ferris DG, Bishai DM, Litaker MS, Dickman ED, Miller JA, Macfee MS. Telemedicine Network Telecolposcopy Compared with Computer-Based Telecolposcopy. J Low Genit Tract Dis 2004; 8:94-101. [PMID: 15874845 DOI: 10.1097/00128360-200404000-00003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare computer-based telecolposcopy with telemedicine network telecolposcopy. MATERIALS AND METHODS An on-site expert and local clinician at two rural sites conducted colposcopic examinations on 264 women. Colposcopic images were captured and transmitted to two other experts at a remote location using a statewide telemedicine system and a computer and modem-based system. Sensitivity and specificity, agreement of examination adequacy and management, effects of delayed interpretations, and costs were compared for each system. RESULTS A greater rate of satisfactory colposcopy results was reported by the telemedicine network (66.1%) compared with computer-based (43.6%) telecolposcopy (p < .0001). Greater rates of cervical biopsy (p = .005) and endocervical curettage (p = .03) were required by delayed telecolposcopy compared with immediate telecolposcopic services. There were no significant differences in sensitivity of detecting cervical neoplasia among the types of the telecolposcopy. Computer-based telecolposcopy cost 28 dollars less per patient than telemedicine network telecolposcopy. CONCLUSIONS Computer-based telecolposcopy may be a reasonable, cost-effective adjunct to on-site colposcopy for evaluating women in medically underserved areas. Synchronous telecolposcopic examination minimizes histologic sampling and improves consultation.
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Affiliation(s)
- Daron G Ferris
- Gynecologic Cancer Prevention Center, Department of Family Medicine, the Medical College of Georgia, Augusta, GA 30912, USA.
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