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Oral Presentation

(V8-03) The Impact on Time, Travel Costs, and Environmental Pollutants from a University Outpatient Telemedicine Program

Monday, April 24
3:25 PM - 3:45 PM
Location: W230 BC

Objectives
Telemedicine is frequently regarded as a model of care that is patient-centric and environmentally friendly, however there is limited evidence documenting this environmental impact. This study sought to describe the travel-related benefits of a university telemedicine program compared to in-person consultations, evaluate potential travel distance, time, and cost savings, and to evaluate the potential reduction in pollution and greenhouse gas emissions.

Methods
The study conducted a retrospective analysis of the telemedicine consultation database at the University of California Davis Health System (UCDHS) evaluating outpatient telemedicine consultations from UCDHS between July, 1996 and December, 2013. Patient consultations were excluded if the patient’s home address was not available, the medical record number was associated with more than one patient, or if the patient was located in a California Department of Corrections and Rehabilitation. The sample included 157 client sites located in 56 of California’s 58 counties. Outcomes measured were potential travel savings, potential time savings, potential cost savings, and potential reduction in pollution and greenhouse gas emissions. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between in-person versus telemedicine site travel routes.

Results
Results were analyzed from 19,246 consultations from 11,281 patients. The use of telemedicine consultations resulted in a mean round-trip travel distance savings of 278 miles (SD = 228, p < .01), an average travel time savings of 245 minutes (SD = 195, p < .01), and an average cost of travel savings of $156 (SD = 129, p < .01). Over the life of the program, telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,993,537. Telemedicine consultations resulted in a total emissions savings of 1,969 metric tons of CO2, 50 metric tons of CO, 3.7 metric tons of NOx, and 5.5 metric tons of VOCs.

Conclusion
The current study evaluated travel related savings resulting from the use of telemedicine in place of in-person consultations. Data from the UCDHS telemedicine program were analyzed from a 17½ year period and showed significant travel distance, cost, and time savings and significant reduction in CO2 emissions. There are several limitations of this study. First, the travel savings calculations were derived assuming that if the telemedicine consultation did not occur the patient would have traveled to UCDHS. Second, the travel savings were estimated assuming that the patients would have traveled in their own private car as opposed to rail, bus, or plane. Despite these limitations, the current study shows the travel associated savings associated with telemedicine consultations. In conclusion, this study provides evidence that telemedicine has significant time-efficiency, cost-efficiency, and positive environmental impacts compared to in-person consultations.

Ilana Sigal

Pediatric Telemedicine Research Analyst
UC Davis Medical Center

Ilana Sigal is a Pediatric Telemedicine Research Analyst at UC Davis Medical Center and has a Master of Public Health from New York University. She works on numerous projects across pediatric telemedicine settings including a grant that seeks to increase pediatric preparedness in pre-hospital and emergency department settings through training and telemedicine and an international venture with the University of the Philippines to determine impact of developing a telemedicine system to transmit data for a low-cost newborn hearing screening device for tracking and follow up.

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Navjit Dullet

Medical Student
Touro University California, College of Osteopathic Medicine

Navjit Dullet is currently a Medical Student at the Touro University California, College of Osteopathic Medicine. Previously, he completed his undergraduate education at the University of California San Diego, and he earned a Masters in Health Informatics from University of California Davis, where he conducted research for the pediatric telemedicine program.

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Taylor Kaufman

Operations Associate
Clover Health, UC Davis

Taylor Kaufman is an Operations Associate at Clover Health. She holds an M.S. in Health Informatics from the University of California, Davis where she conducted research within the pediatric telemedicine program utilizing Arc GIS software.

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Parul Dayal

PhD student
University of California, Davis

Parul Dayal is a PhD student in the graduate group of Epidemiology and is affiliated with the Department of Pediatrics at the UC Davis Medical Center. As part of the Pediatric Telemedicine group, she works on evaluating the clinical and cost effectiveness of Telemedicine programs for improving access to care in rural regions of Northern California, with a focus on emergency and critical care. Her other interests include socio-demographic disparities in the quality of care delivered to children.

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Madan Dharmar

Associate Professor in Residence
Univeristy of California Davis Health System

Dr Dharmar is an Associate Professor in Residence in the Department of Pediatrics at the University of California, Davis Health System. A physician, clinical epidemiologist and federally funded researcher, Dharmar’s area of expertise is health services research, telehealth and, mHealth. His research focus is in the development of quality measures to evaluate health care and apply innovative technologies to improve health-care delivery. He is currently the principal investigator and director for the federally funded, Pediatric Emergency Assistance for Newborns Using Telehealth (PEANUT) Program.

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Anthony Smith

Deputy Director of the University of Queensland’s Centre for Online Health
University of Queensland

Dr Anthony Smith is an Associate Professor and Deputy Director of the University of Queensland’s Centre for Online Health (COH). He also holds an Adjunct Professor appointment at the University of Southern Denmark's Centre of Innovative Medical Technology. Specific research interests include the evaluation of feasibility, cost-effectiveness and diagnostic accuracy of telemedicine applications in the context of paediatrics and child health.

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James P. Marcin

Professor, Pediatric Critical Care; Director, Pediatric Telehealth Services
UC Davis Health

Dr. Jim Marcin is a Professor of Pediatrics, Chief of Pediatric Critical Care Medicine, Interim Chief of Pediatric Pulmonary Medicine, and Interim Medical Director of the Center for Health and Technology at UC Davis Health. He is also a Major Professor in the Graduate Group in Epidemiology, a faculty member of the UC Davis Center for Healthcare Policy and Research, a faculty member of the UC Davis School of Public Health, and a faculty member in the UC Davis Health Informatics Graduate Group.

Dr. Marcin’s expertise and research interests include the use of telemedicine in pediatric critical care and emergency medicine, inpatient and outpatient care. Dr. Marcin is an internationally recognized speaker and has been conducting research into the impact of telemedicine on quality of care, patient safety, and financial outcomes. He is the founding Chair of the American Telemedicine Association’s Pediatric Special Interest Group and has provided guidance to his colleagues across the nation on telehealth program development.

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Jamie Kissee

Pediatric Telemedicine Research Manager
University of California Davis

Jamie Kissee obtained a Masters of Arts in Psychology from San Diego State University with an emphasis in Developmental Psychology. She now serves as the Pediatric Telemedicine Research Manager for the UC Davis Health System's Pediatric Telemedicine Program. Her interests include interventions to improve pediatric health outcomes, pediatric mental health, and improving systems of care.

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(V8-03) The Impact on Time, Travel Costs, and Environmental Pollutants from a University Outpatient Telemedicine Program



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