Telemedicine Visits for Medically Complex Kids Reduce Serious Illness, Health Costs

(Reuters Health) – Providing telemedicine in addition to comprehensive care for medically complex children can reduce care days outside the home, serious illness, and health care costs, a randomized clinical trial shows.

All 422 children in the trial received care at the High-Risk Children’s Clinic at the University of Texas Health Science Center in Houston. They all had at least two hospitalizations or at least one pediatric intensive care unit admission in the previous year, and they had a greater than 50% estimated risk of a repeat hospitalization without comprehensive care.

Every child in the study received comprehensive care, which included low patient-to-primary care provider ratios, round the clock phone access to primary care providers, and hospital consultations from primary care providers. In addition to this, 209 patients were randomized to also receive telemedicine services to facilitate remote audiovisual consultations with primary care providers.

The mean follow-up was 1.19 years in the telemedicine group and 1.24 years in the group randomized to comprehensive care only. The primary endpoint of the study was reduction in care days outside the home in a clinic, emergency department or hospital; rates of serious illness; and health system costs.

Telemedicine was associated with significantly fewer days of care outside the home (12.94 vs 16.94 per child-year) than comprehensive care alone. Telemedicine was also associated with significantly lower rates of serious illness (0.29 vs 0.62 per child-year), and lower mean total health system costs ($33,718 vs $41,281 per child-year).

“We were trying to prove that telemedicine visits, in addition to the regular primary care for children with medical complexity, were similar or equally effective as in-person visits,” said lead study author Dr. Ricardo Mosquera, an associate professor of pediatric pulmonary medicine at McGovern Medical School at UTHealth Houston.

“However, we were surprised that our results showed a greater outcome by reducing days of care in-clinic, emergency, and hospital settings, rates of serious illness, and costs,” Dr. Mosquera said by email.

During the telemedicine visits, providers were more proactive with assessing and initiating a plan of care and reducing delays for the patients seeking medical attention, Dr. Mosquera said.

“For example, if a caregiver seeks medical advice on a weekday at 3 pm, rather than waiting to be seen in person the following business day, we can offer an immediate plan/treatment via a telemedicine consult,” Dr. Mosquera said.

One limitation of the study is that primary care providers and families weren’t blinded to the intervention, the authors note in Pediatrics. It’s also possible that results from this single-center trial might not be generalizable to outcomes elsewhere.

Still, the study reinforced that telemedicine visits could be delivered safely, without any adverse outcomes for children who received care this way instead of in person, said Dr. Christopher Stille, a professor and section head for general academic pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado.

“Telemedicine can really make a difference in the care of medically complex kids, keeping them and their families at home and out of the hospital,” Dr. Stille, who wasn’t involved in the study, said by email. “Of course, care teams should be designed so they have the resources to provide telemedicine visits, and clinicians and teams should be appropriately paid for their efforts.”

SOURCE: Pediatrics, online August 30, 2021.

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