Operations and Implementation

ePoster Presentations

EP-145 - Data-Driven Public Health Methods for Maximum Impact: Targeting Chronic Disease Through School-Based Telehealth

Tuesday, May 1
11:55 AM - 12:10 PM
Location: Education Zone, Booth 2416, Screen 3

As the field of telehealth has moved from pilot programs to population-level approaches, research in the field has in turn progressed from feasibility and acceptability studies to those that examine the quality of care and value added. However, some of these studies have created pause as "unbridled" telehealth may in fact decrease efficiency which has contributed to the narrative that telehealth is not, in fact, cost effective. In order to combat this narrative, it is of upmost importance that we take on what has become known as "precision public health methods" in our design of telehealth programs. In the world of public health, "precision public health" describes data-driven approaches that take into account geographic distribution of disease and gaps in the healthcare system in order to guide interventions for upmost efficiency and impact. Here we will discuss how these methods have been employed throughout the design, implementation and now evaluation stages of a multidisciplinary school-based telehealth program.
From its inception our program has aimed to increase access to care in a particularly rural state with a physical and mental health provider shortage and a costly chronic disease burden. Development of the program has been led by data in two ways. First, three costly chronic disease use-cases were identified and telehealth solutions were designed that added efficiency to the system, rather than duplicating care. The physical health component of our program has targeted pediatric asthma, as one of the most common chronic diseases of childhood and attention deficit/hyperactivity disorder as a common chronic disease that directly impacts educational disparities. The telemental health program was designed to compliment existing school-based mental health services by targeting children affected by childhood traumatic stress and treating PTSD. These specific use cases addressed concerns of key stakeholders such as patients, school-districts, payers and state law makers as well as existing gaps in the health care system using proven standards of treatment.
Secondly, geographic data was used to guide program implementation and expansion to target the areas of highest need. The pilot sites were selected based upon rurality and provider shortages as well as burden of health care disparities. Once feasibility in these pilot sites was established, rapid program expansion was guided by careful "heat mapping" of the most expensive chronic disease burden.
These targeted approaches have driven quality, health and cost-savings outcomes. Outcome data regarding improved adherence to treatment guidelines when compared to traditional in-person methods, increased symptom management and analysis of impact on costly utilization patterns will be presented. The authors will discuss specific steps in developing and implementing a school-based telehealth program that is focused on increasing access to care and service utilization while improving management of chronic disease and decreasing overall cost for chronic health conditions in a specific youth population. However, this program will serve as a "case study" for use of precision public health techniques and the authors will use their experience to present lessons that are generalizable to telehealth programs across a broad spectrum of applications.

Learning Objectives:

Kathryn Cristaldi

Medical Director, School-Based Health
Medical University of South Carolina

Kathryn King Cristaldi, M.D., MHS, is the Medical Director for School-Based Health and an Assistant Professor in the Division of General Pediatrics at MUSC Children’s Hospital. She oversees the functioning of both in-person and telemedicine school-based health centers throughout the state.

Dr. Cristaldi has a special interest in extending the reach of primary care and preventative medicine to underserved children through school-based health and most specifically through telehealth. Throughout her career she has sought out opportunities to ensure the health and wellness of children using public health methods. She currently serves as the representative from the AAP Section on Telehealth Care to the Pediatric Academic Society Program Committee.

As the medical director for school-based health in the Center for Telehealth, Dr Cristaldi directs programmatic functioning, evaluation and the clinical care provided by pediatricians, nurse practitioners and herself in school-based health centers and telehealth centers in more than 50 schools in South Carolina. During her time as medical director the program has more than doubled in size and continues to rapidly expand throughout the state. Dr. Cristaldi chairs the South Carolina School-Based Telehealth Workgroup, a network of hospital systems and providers who collaborate with each other as well as state agencies to implement telehealth programs in school districts with the highest health and educational disparities. In addition, Dr. Cristaldi continues to use her experience and skills to advocate at the state and national level for increased access to care through telehealth and has been invited to share her telehealth expertise at the National School-Based Health Alliance, Pediatric Academic Society and the South Carolina Telehealth Summit.

Dr. Cristaldi received her undergraduate education at the University of Dayton and earned her medical degree at the Medical College of Virginia at Virginia Commonwealth University. She completed her pediatric residency at MUSC, and an academic generalist fellowship at the Johns Hopkins University, earning a Master of Health Science degree from the Johns Hopkins Bloomberg School of Public Health.

Presentation(s):

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Regan Stewart

Assistant Professor
Medical University of South Carolina

Dr. Stewart is an assistant professor in the Mental Health Disparities and Diversity Program within the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. She completed her undergraduate degree in Spanish at the College of Charleston, a Master’s in Early Childhood Education at the College of Charleston, a Master’s in Clinical Psychology at the University of Mississippi and her Ph.D. in Clinical Psychology at the University of Mississippi. She completed her internship and postdoctoral training at MUSC. Her work primarily focuses on health disparities among trauma-exposed youth and the use of telemedicine to address mental health disparities.

Presentation(s):

Send Email for Regan Stewart


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