Pediatric Neurology Telemedicine Consultations Reduce Hospitalizations, ED Visits

Children with neurologic conditions who had neurology consultations via telemedicine had significantly fewer hospital encounters than those who obtained in-person care, according to a recent study published in JAMA Network Open.

The rate of all-cause hospital encounters was approximately four times lower among those who received neurology consultations over telemedicine in their local communities, compared with those who traveled to in-person clinics, the researchers concluded.

“Our findings suggest that by improving subspecialty access in underserved communities and enhancing care coordination among physicians, telemedicine may reduce the utilization of high-cost hospital care for children with neurologic conditions,” the authors wrote.

The research team aimed to evaluate the association between access to telemedicine clinics and hospitalization encounters among underserved kids with neurological conditions.

The Division of Pediatric Neurology at University of California Davis Children’s Hospital (UCDCH) completed more than 1,000 telemedicine visits with patients in underserved and rural communities between Jan. 2009 and Dec. 2018.

The telemedicine consultations were offered for new and follow-up appointments at 13 remote sites in northern California.

Remote staff and primary care physicians collected each patient’s vital statistics and history, performed a detailed physical examination and recorded the findings and discussed visit recommendations together with the patient and neurologist.

The pediatric neurologist conducted the consultation in a telemedicine consultation room that had a computer with the electronic health record (EHR).

Patients in the study were younger than 18 years old and had a home address within the UCDCH 33-county service area in northern California. Patients also completed at least one clinic visit with a UCDCH pediatric neurologist between Jan. 2009 and July 2017 over telemedicine or in-person. A patient’s time in the study was considered as the time between the patient’s first completed neurology appointment and the date when the patient turned 19 years old.

Researchers took demographic, clinical and utilization data from the UCDCH EHR.

The telemedicine group included patients who scheduled one or more of their outpatient neurology appointments in a telemedicine clinic. Patients in the in-person group scheduled all of their appointments in the in-person clinics.

The research team compared the rate of all-cause and neurologic hospital encounters between the telemedicine and in-person groups.

Overall, 378 patients used telemedicine consultations, while 3,791 had typical in-person visits.

Of the patients who received care through telemedicine consultations, 40 had 77 all-cause hospital encounters — an emergency department visit or hospital admission — and 28 had 49 neurologic hospital encounters. Comparatively, 1,024 in-person patients had 3,455 all-cause encounters and 473 in-person patients had 1,531 neurologic hospital encounters.

Patients who used telemedicine had an average household income of $42,600, compared to $69,300 in the in-person cohort, the study said.

Those in the telemedicine group were less likely to have private insurance and more likely to live in a household with a lower education level than the in-person group, according to the study.

Patients in the telemedicine cohort also had a higher neurology clinic appointment completion rate than those who had traditional in-patient visits.

What’s more, the rate of encounters for neurologic-related reasons was almost twice as low for patients who had telemedicine consultations.

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