Integrated Multimodality Telemedicine to Enhance In-Home Care of Infants During the Interstage Period
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ORIGINAL ARTICLE
Integrated Multimodality Telemedicine to Enhance In‑Home Care of Infants During the Interstage Period Carolyn C. Foster1,2,3,4 · Michelle Steltzer5 · Amanda Snyder5 · Carrie Alden5 · Khrystyna Helner2 · Dana A. Schinasi1,2,4,6 · Katie Bohling4 · Kiona Allen1,5,7 Received: 13 August 2020 / Accepted: 8 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Performing interstage home monitoring using digital platforms (teleIHM) is becoming commonplace but, when used alone, may still require frequent travel for in-person care. We evaluated the acceptability, feasibility, and added value of integrating teleIHM with synchronous telemedicine video visits (VVs) and asynchronous video/photo sharing (V/P) during the interstage period. We conducted a descriptive program evaluation of patient-families receiving integrated multimodality telemedicine (teleIHM + VV + V/P) interstage care from 7/15/2018 to 05/15/2020. First, provider focus groups were conducted to develop a program logic model. Second, patient characteristics and clinical course were reviewed and analyzed with univariate statistics. Third, semi-structured qualitative interviews of family caregivers’ experiences were assessed using applied thematic analysis. Within the study period, 41 patients received teleIHM + VV + V/P care, of which 6 were still interstage and 4 died. About half (51%) of patients were female and 54% were a racial/ethnic minority. Median age was 42 days old (IQR 25, 58) at interstage start, with a median of 113 total days (IQR 72, 151). A total of 551 VVs were conducted with a median 12 VVs (IQR 7, 18) per patient. Parents sent a median 2 pictures (IQR 0–3, range 0–82). Qualitatively, families reported an adjustment period to teleIHM, but engaged favorably with telemedicine overall. Families felt reassured by the oversight routine telemedicine provided and identified logistical and clinical value to VVs above teleIHM alone, while acknowledging trade-offs with in-person care. Integration of multimodality telemedicine is a feasible and acceptable approach to enhance in-home care during the interstage period. Keywords Telemedicine · Video visit · Interstage home monitoring · Remote patient monitoring · Advanced practice provider · Nurse coordinator * Carolyn C. Foster [email protected] 1
Abbreviations CDC Centers for Disease Control TeleIHM Tele-interstage home monitoring SVP Single ventricle physiology VVs Video visits V/P Video/photo sharing ED Emergency department APN Advanced practice nurse RN Registered nurse
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
2
Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
3
Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
4
Telehealth Programs, Ann & Robert H. Lurie Children’s Hospital of Ch
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