The purpose of this study is to assess if the benefits for children with medical complexity (CMC) receiving comprehensive care (CC) in an enhanced medical home can be further improved by enhanced telemedicine program (ETM) provided during clinic hours using mobile devices to measure temperature\& oxygen saturation, auscultate the heart \& lungs, and view the skin, throat, \& tympanic membranes in the home.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
300
To promote prompt effective care for medically complex children at all hours, we developed an outpatient comprehensive care (CC) program at the University of Texas Health Science Center at Houston (UTH) that now includes a hospital consultation service by the outpatient CC providers (the hospital component) and a conventional telemedicine (CTM) audio-visual program (the home component).
An enhanced telemedicine program (using HIPAA-compliant, mobile TytoCareTM devices) will be added to CC to allow providers to remotely visualize the skin, throat, \& ears, auscultate the heart \& lungs, and measure illnesses during clinic hours and chronic illnesses during the detailed patient evaluation to be conducted at least every 6 months by "virtual patient rounds" in the home. These visits will involve the parent(s), the PCP, and if needed any of 10 specialists, particularly pulmonology, gastroenterology, neurology, and physical medicine and rehabilitation. A social worker, nutritionist, or psychologist will be involved as needed. Each PCP will perform 2-3 virtual patient rounds per week to proactively identify medical problems, suboptimal adherence to treatment, dosing errors, or other problems and intervene before CMC develop a serious illness or require avoidable clinic visits, Emergency Department visits, or hospitalizations.
The University of Texas Health Science Center at Houston
Houston, Texas, United States
RECRUITINGNumber of days care provided in a medical setting
Time frame: end of study(about 24 months)
Total number of episodes of serious illnesses (causing death, pediatric ICU admission, and hospital stay > 7d).
Time frame: end of study(about 24 months)
Cost effectiveness of ETM
this is defined strictly as a reduction in serious illnesses without an increase in health system costs, a decrease in health system costs without an increase in serious illnesses, or a reduction in both
Time frame: end of study(about 24 months)
All cause infections on admission to the hospital
Time frame: end of study(about 24 months)
Total numbers of clinic visits
Time frame: end of study(about 24 months)
Total number of emergency department visits
Time frame: end of study(about 24 months)
Total number of hospital days
Time frame: end of study(about 24 months)
Total number of Pediatric Intensive Care Unit (PICU) days
Time frame: end of study(about 24 months)
Total number of deaths
Time frame: end of study(about 24 months)
Parent ratings of care assessed using the Consumer Assessment of Healthcare Providers and Systems Survey
This survey consists of 5 questions. The first 4 are scored from 1(never)-4(always) for a maximum score of 16 , a higher number indicating better care. The fifth question is scored form 0-10 a higher number indicating a better provider.
Time frame: end of study(about 24 months)
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