Pre-surgery evaluations by telephone decrease travel and cost for families of children with cerebral palsy
John D Robinson1, John D Prochaska2, David A Yngve1
1Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
Insights
Telephone-based telemedicine evaluations significantly reduced travel for families of children with cerebral palsy, saving miles and costs. This approach proved accurate and effective for surgical eligibility, benefiting families needing specialized care.
Area of Science:
- Pediatric Orthopedics
- Telemedicine
- Healthcare Access
Background:
- Children with cerebral palsy require specialized care, often involving long-distance travel for families.
- Rural populations face significant burdens due to travel for medical appointments.
- Selective percutaneous myofascial lengthening surgery necessitates pre-operative assessments.
Purpose of the Study:
- To evaluate the effectiveness of telephone-based telemedicine for surgical eligibility assessment.
- To quantify reductions in travel mileage, expenses, and carbon emissions.
- To determine the accuracy of telephone assessments in identifying surgical candidates.
Main Methods:
- Retrospective review of 279 patients (2010-2012) undergoing telephone screening and X-rays.
- Geographic Information System (GIS) used for mileage and cost calculations.
- Prospective study of 195 patients (2014-2015) to assess accuracy and effectiveness.
Main Results:
- Saved 106,070 miles and $55,326 over 3 years, a 38% reduction.
- Families saved an average of 658 miles and $343.64 per visit.
- Increased distance from the health center correlated with higher telephone screening utilization (OR: 1.101).
- 86% of patients were deemed likely surgical candidates via telephone prescreening.
Conclusions:
- Telephone-based telemedicine is an effective and accurate method for assessing surgical eligibility.
- This approach significantly reduces travel burden for families of children with cerebral palsy.
- The method offers substantial cost savings and improved healthcare access for specialized surgical care.
Introduction:
Children with cerebral palsy need highly specialized care. This can be very burdensome for families, particularly in large rural states, due to the need for long-distance travel to appointments. In this study, children undergoing the selective percutaneous myofascial lengthening surgery utilized a telephone-based telemedicine evaluation to assess for surgical eligibility. The goal was to avoid a separate preoperative clinic visit weeks before the surgery. If possible, eligibility was determined by telephone, and then, the patient could be scheduled for a clinic visit and possible surgery the next day, saving the family a trip. The purposes of the study were to calculate estimated reductions in miles traveled, in travel expenses, and in carbon emissions and to determine whether the telephone assessment was accurate and effective in determining eligibility for surgery.
Methods:
From 2010 to 2012, 279 patients were retrospectively reviewed, and of those, 161 mailed four-page questionnaire and anteroposterior pelvis X-ray followed by a telephone conference. Geographic information system methods were used to geocode patients by location. Savings in mileage and travel costs were calculated. From 2014 to 2015, 195 patients were additionally studied to determine accuracy and effectiveness.
Results:
The telephone prescreening method saved 106,070 miles in transportation over 3 years, a 38% reduction with US$55,326 in savings. Each family saved an average of 658 (standard deviation = 340) miles of travel and US$343.64 (standard deviation = US$178) in travel expenses. For each increase of 10 miles in distance from the health center, the odds of a patient utilizing telephone screening increased by 10% (odds ratio: 1.101, 95% confidence interval: 1.073-1.129, p < 0.001). After the telephone prescreening, 86% were determined to be likely candidates for the procedure. For 14%, a clinic visit only was scheduled, and they were not scheduled for surgery.
Conclusion:
Families seeking specialized surgical care for their disabled children particularly benefited from this approach.
