From connecting Medicare beneficiaries in rural California to specialty care to facilitating dialog among diabetic teens in New York City, telehealth is bridging gaps in healthcare access and quality in the United States and beyond.
These solutions are sorely needed: According to a recent Commonwealth Fund report, the United States ranks last in terms of primary care access, despite spending nearly double that of other countries on healthcare per person.
Advancing Access with Telehealth: Case Studies on Bridging Gaps in Care presents four telehealth interventions empowering patients across the country and overcoming the barriers of time, distance and cost as healthcare faces an impending physician shortage.
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In an engaging interview format, this 55-page resource highlights the following telehealth interventions:
- Adventist Health: An integrated health plan serving both underserved rural and low income urban populations improves patient health and costs with such time-sensitive technology as virtual visits with specialists, an eICU and telestroke equipment.
- Yale School of Nursing: Teen diabetics overcome their fear of stigmatization by logging onto a Web site for other teen diabetics and engaging in self-management techniques that help to improve both metabolic control of diabetes and quality of life for themselves and their families.
- Iowa Chronic Care Consortium: A Medicaid diabetes management project combines telehealth and care management components, resulting in substantial savings over the program's two-year period.
- Unicare Home Health: A San Diego-based home health agency with a diverse, multi-lingual population overcomes such barriers as the lack of reimbursement for telehealth, with the result of driving hospital readmittance rates down from 14 to 11 percent.
Telehealth Thought Leaders:
, Director of Rural Health Services at Adventist Health, and Christine Martin, Telemed Lead, discuss how Adventist Health, an integrated health system with 17 hospitals in 14 states from California to Washington State and Hawaii, has utilized telehealth to help individuals and families not only in its large rural population but also its low-income, underserved urban population by providing faster, more convenient access to specialty care.
They also discuss the following:
Their new collaboration with Blue Shield of California in which patients are diagnosed and treated by specialists from across the state through interactive video technology available at nine local Adventist sites; and
Recent technologies, including tele-ICUs and telestroke monitors, particularly important given the time-sensitivity of strokes, helping to improve patient health and overall costs, and enable access in remote or urban areas.
Dr. Margaret Grey, DrPH, RN, FAAN, Dean of Yale School of Nursing, and Annie Goodrich professor at the Yale School of Nursing, examine the wider implications of managing diabetes when teenagers are involved. Addressing adolescents' 'black and white thinking' and fear of looking different, the program provides the skills to manage their disease and to think about it in a new way.
They also cover the following:
- An online program kids can do at their leisure, incorporating a monitored discussion board for communication with others like them;
- Telehealth's support for patients and families in managing their diabetes through their teen years to reduce their risk of long-term complications later on;
- Results of several clinical trials on an advanced diabetic education project and a life skills program that improved overall health and quality of life for children with diabetes; and
- Social considerations for child diabetics as they transition to adolescence.
William Appelgate, executive director of the Iowa Chronic Care Consortium, presents "Keep It In Check," a diabetes management program developed for the Iowa Medicaid program focused on reducing the burden of diabetes and comorbid depression in a statewide Medicaid population over a two-year period using telehealth and care management.
He shares the results of the program, including the following:
- 6 percent reduction in diabetes event rate; 14 percent against controls;
- Total cost of care reduced 18 percent in the first year; 32 percent in second; 20 percent combined;
- 54 percent reduction in hospitalizations over two-year period;
- 93 percent of responding participants (including disenrolled) felt they benefited from the program and that it had improved their quality of life;
- Quarterly depression screenings on all participants showing a reduction in the severity of depression over time.
Jeremie Meyers, RN, administrator and co-owner of Unicare Home Health, details how the San Diego-based home health agency overcame the lack of reimbursement for telehealth by using an asynchronous remote patient monitoring system during the home visit, and was able to keep more patients at home, reducing hospital readmission rates in this population from 14 to 11 percent.
He also discusses the following:
- Addressing the needs of a multi-lingual population with multi-cultural staff ranging from Iranian to Russian;
- Coping with the dearth of quality home care and lack of reimbursement in California for telehealth - by using a store and forward asynchronous monitor that improved the quality of care for patients;
- Reductions in congestive heart failure (CHF) from 14 percent to 11.4 percent; and
- How he handled the lack of physician involvement due to reimbursement challenges.
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