Effectiveness of Telemedicine in Replacing In-Person Evaluation for Acute Childhood Illness in Office Settings

Abstract

For the purpose of reducing the social and economic burden imposed by common acute childhood illness, we developed a telemedicine model to enable diagnosis and treatment of illness episodes presenting in pediatric office settings. The study objective was to assess the effectiveness of this telemedicine model in replacing illness visits to traditional healthcare settings and to compare effectiveness of this model (base model) with that of alternative models including simple office laboratory tests and albuterol administration (simple model) or a complete complement of tests and procedures (extended model). Eligible subjects had an acute problem and were seen in the pediatric primary care practice or pediatric emergency department of the University of Rochester Medical Center. All subjects were seen by the setting's usual physician. Subjects were also evaluated, based on random assignment, by a study physician in person or by a study physician via telemedicine. Effectiveness was defined as completion of the visit to the point that diagnosis was made. Forms completed by study physicians, and standard medical records indicating the tests and procedures requested for the purpose of completing the visit, were used to identify the model used in completing the visit. Effectiveness (proportion of visits completed) of the base model was assessed and its effectiveness was compared to that of simple and extended telemedicine models. Among 520 randomized visits, 492 were evaluated by study physicians in person (253) or via telemedicine (239). Using the base model, study physicians completed 74.1% of visits via telemedicine compared to 76.7% for study physicians in person and 76.0% for usual physicians. The simple model increased completion rates substantially. Using this model, study physicians completed 84.9% of visits via telemedicine compared to 86.6% for study physicians in person and 85.2% for usual physicians. The extended model increased effectiveness in completing visits still more, with telemedicine study physicians completing 97.1% of visits compared to 96.8% for in-person study physicians and 100% for usual physicians. Approximately 85% of illness visits presenting to primary care pediatric practice could be completed using a telemedicine model that included only simple office laboratory testing and albuterol administration.