OBJECTIVE
This study evaluated the quality and cost effectiveness of health care provided in urban and rural elementary school-based telehealth centers, using plain old telephone system (POTS) technology.
METHODS
A telehealth school-based model was developed that used a full-time school nurse, half-time mental-health consultant, linked pediatric practice, and linked child psychiatrist via POTS with an electronic stethoscope; ears, nose, and throat endoscope; and otoscope. One rural and 1 urban center were evaluated. Providers, nurses, children, and parents completed satisfaction questionnaires. Providers and nurses also evaluated how well telemedicine supported their clinical decision making. Parents were asked how use of the center affected them financially and at work.
RESULTS
Of the combined 3461 visits to school nurses at both centers, 4.3% resulted in 150 telehealth consultations referrals; 142 (95%) were completed during the 2-year project. The most common teleconsult diagnoses were otitis media, pharyngitis, dermatitis, and upper respiratory infections. Provider, nurse, child, and parent satisfaction all were high. Providers' and nurses' decision confidence scores ranged from a low of 4 to a high of 4.8 on a 5-point scale. Average family savings per encounter were 3.4 hours of work time (43 dollars) and 177 dollars in emergency department or 54 dollars in physician costs. Including travel, savings for families ranged from 101 dollars to 224 dollars per encounter. Thirteen children received telepsychiatric evaluations resulting in diagnoses of depression and attention-deficit/hyperactivity, anxiety, and conduct disorders.
CONCLUSIONS
Telehealth technology was effective in delivering pediatric acute care to children in these schools. Pediatric providers, nurses, parents, and children reported primary care school-based telehealth as an acceptable alternative to traditional health care delivery systems. The POTS-based technology helps to make this telehealth service a cost-effective alternative for improving access to primary and psychiatric health care for underserved children.
[1]
P. Newacheck,et al.
Children's access to primary care: differences by race, income, and insurance status.
,
1996,
Pediatrics.
[2]
D. Kaplan,et al.
A comparison study of an elementary school-based health center: effects on health care access and use.
,
1999,
Archives of pediatrics & adolescent medicine.
[3]
M. Bujnowska-Fedak,et al.
System of telemedicine services designed for family doctors' practices.
,
2000,
Telemedicine journal and e-health : the official journal of the American Telemedicine Association.
[4]
James F. Courtney,et al.
A Field Study of Organizational Factors Influencing DSS Success
,
1985,
MIS Q..
[5]
S. Guendelman,et al.
Access to care for children of the working poor.
,
2001,
Archives of pediatrics & adolescent medicine.
[6]
M. Rosenbach,et al.
Access for Low-income Children: Is Health Insurance Enough?
,
1999,
Pediatrics.