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Randomized Controlled Trial
. 2019 Nov;25(11):1123-1132.
doi: 10.1089/tmj.2018.0186. Epub 2019 Jan 30.

Home-Based Telemedicine for Children with Medical Complexity

Patricia M Notario  1 , Elise Gentile  2 , Matthew Amidon  3 , Denise Angst  4 , Cheryl Lefaiver  2 , Kathleen Webster  2
Affiliations
Randomized Controlled Trial

Home-Based Telemedicine for Children with Medical Complexity

Patricia M Notario et al. Telemed J E Health. 2019 Nov.

Abstract

Background: Children with medical complexity (CMC) are high utilizers of health care services. Telehealth encounters may provide a means to improve care outcomes for this population.Objective: To evaluate the feasibility, usability, and impact of an in-home telehealth device in the care of CMC.Methods: This single-center feasibility study employed a nonblinded randomized clinical trial design. English-speaking caregivers of children within a pediatric complex care program with home Wi-Fi were eligible for participation. Participants were randomized 1.5:1 with stratification based on tracheostomy status to a control group that received usual care or an intervention group that received a telehealth device for in-home use. Patients were followed up for 4 months. The primary outcome was successful device connectivity and data transmission. Data included clinician encounter device usability; caregiver satisfaction; and encounter type, purpose, and cost. Descriptive statistics, negative binomial regression, and Kaplan-Meier plot were used for analysis.Results: Twenty-four patients were enrolled (9 controls, 15 in the intervention group) in September 2016. The telehealth device was attempted in 73 encounters. Device connectivity was successful 96% of the time. Image and sound quality were acceptable in 98% of visits. Caregivers expressed their overall satisfaction with the device. The hospitalization rate was lower in the intervention group (0.77 vs. 1.14 intensive care unit days/patient-months), resulting in $9,425/USD per patient savings compared with the control group.Conclusion: Despite small sample size and short observation period, this study demonstrated that use of an in-home telehealth device is feasible, well received by caregivers, and can result in decreased hospitalizations when compared with usual care.

Trial registration: ClinicalTrials.gov NCT02849938.

Keywords: home health monitoring; pediatrics; telehealth; telemedicine.

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Conflict of interest statement

No competing financial interests exist.

Figures

<b>Fig. 1.</b>
Fig. 1.
Tyto™ device setup and caregiver view. Image provided by TytoCare, Inc.
<b>Fig. 2.</b>
Fig. 2.
CONSORT diagram.
<b>Fig. 3.</b>
Fig. 3.
Kaplan–Meier survival analysis demonstrating time to first hospitalization by study group.
See this image and copyright information in PMC

References

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