Value

Oral Presentation

(V8-02) Evaluation of a School-Based Telehealth Program Delivered to a Large Southwestern Metropolitan Area

Monday, April 24
3:05 PM - 3:24 PM
Location: W230 BC

Objectives
Telemedicine uses advanced telecommunications technology for diagnosis and treatment when the provider and patient are physically separated. Children’s Health System of Texas has established a school-based telehealth program with 97 schools in the Dallas/Fort Worth (DFW) area. We evaluated the implementation of the school-based telehealth program in changing the utilization of healthcare system, and expenditures for children who participated in the program between October 2014 and December 2015. This presentation addresses the health of the population and the cost of healthcare dimensions of the Triple Aim framework.
Outcome Objectives

1. Describe our initial approach at an outcomes-based evaluation processes
2. Present new approaches to evaluate the effectiveness of the school-based telehealth program in reducing emergency department (ED) visits, hospitalization, and ambulatory visits, and in reducing healthcare costs
3. Discuss the opportunities and challenges in data linkages for evaluating health care utilization in population health research

Methods
We evaluated the impact of our school-based telehealth program on the ED volumes and the financial impact to the institution through volume reductions (cost avoidance). Outcomes data include: frequency of healthcare visits (i.e., ED visit, hospitalization, and ambulatory care visit) preceding and following their virtual visit. We examined the data on healthcare utilization (ED visits, hospitalization, and ambulatory visits) one year before and one year following the school telehealth visits for all patients. The data were extracted for the same diagnosis as the school telehealth encounter.

Results
In our preliminary analyses examining the ED visits in a single hospital system (two urban hospitals and one ambulatory care center), we found minimal changes to the ED use. Only 14 patients used the ED for the same diagnosis as their school-based encounter, and only 20 ED visits out of over 3,000 school-based encounters were documented among these patients. With over 3,000 school-based encounters, and over 130,000 ED visits annually, the program’s impact to the ED visits utilization within the single hospital system was minimal.

Conclusion
Many of the patients impacted by the school-based telehealth program reside outside of the geographical scope of our ED. Because of the large degree of competition among hospitals in the DFW area, many patients likely sought emergency care elsewhere. With the current analysis focusing on our hospital, actual impact of the school-based program on healthcare utilizations remains unknown. To address this issue, we are currently conducting a secondary data analysis using a centralized database capturing 90% of the DFW hospital market and billed charges associated with the healthcare visits. A matched control group will be identified based on the demographic characteristics, residential zip code, and previsit characteristics (e.g., diagnosis, disease history, and comorbidities) to better understand overall healthcare utilization across the competing hospital systems. The findings will be presented in the context of the Triple Aims model. The implication for future research and population health management will be discussed.

Michiko O. Clutter

Senior Research Scientist
Children's Health System of Texas

Dr. Michiko Otsuki Clutter is a Senior Research Scientist at Children’s Health System of Texas, Children’s Medical Center Dallas, and an Adjunct Assistant Professor of Health Promotion and Behavioral Sciences at University of Texas School of Public Health. At Children’s Health, she has been involved in the design and evaluation of a variety of programs in the pediatric populations in the healthcare and community settings. As a developmental-health psychologist, her research programs have focused on identifying psychosocial factors and strategies that may improve health outcomes of the underserved populations and children with chronic illnesses (e.g., asthma).

Presentation(s):

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Brian D. Robertson

Manager, Virtual Health Economics
Children's Health System of Texas

Dr. Robertson is the Manager of Virtual Health Economics at Children’s Health System of Texas, Children’s Medical Center Dallas, and an Instructor at UT Southwestern Medical School in the Division of Emergency Medicine. His role is to evaluate the success of virtual health programs across the hospital. He has over 10 years of research and evaluation experience across clinical and non-clinical services.

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