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Telemedicine for Children With Medical Complexity: A Randomized Clinical Trial
Ricardo A Mosquera1,2, Elenir B C Avritscher3,2, Claudia Pedroza3,2
1Departments of Pediatrics ricardo.a.mosquera@uth.tmc.edu.
Insights
Telemedicine integrated with comprehensive care (CC) likely reduces hospitalizations and costs for medically complex children. This approach improves outcomes and lowers healthcare expenses for this vulnerable population.
Area of Science:
- Pediatric Health
- Health Services Research
- Digital Health
Background:
- Telemedicine is increasingly utilized in healthcare, but its precise value, particularly for complex pediatric populations, remains under investigation.
- Comprehensive care (CC) models aim to improve outcomes and manage costs for medically complex children.
- Assessing the impact of telemedicine within CC is crucial for optimizing care delivery.
Purpose of the Study:
- To evaluate the effectiveness of adding telemedicine to comprehensive care (CC) for medically complex children.
- To determine if telemedicine can reduce healthcare utilization, serious illness rates, and associated costs.
Main Methods:
- A single-center randomized clinical trial compared CC with telemedicine versus CC alone.
- The primary outcome was reduced care days outside the home (clinic, ED, hospital).
- Secondary outcomes included the rate of serious illnesses and total health system costs, analyzed using Bayesian methods.
Main Results:
- The addition of telemedicine to CC showed a high probability (99%) of reducing care days outside the home (0.80 rate ratio).
- Telemedicine also demonstrated a probable reduction in serious illness rates (0.68 rate ratio) and health system costs (0.85 cost ratio).
- These benefits were observed in a cohort of 422 medically complex children.
Conclusions:
- Integrating telemedicine into comprehensive care likely improves outcomes for medically complex children.
- Telemedicine addition to CC is associated with reduced healthcare utilization and costs.
- This study supports the value of telemedicine in managing complex pediatric conditions.
Background:
Telemedicine is widely used but has uncertain value. We assessed telemedicine to further improve outcomes and reduce costs of comprehensive care (CC) for medically complex children.
Methods:
We conducted a single-center randomized clinical trial comparing telemedicine with CC relative to CC alone for medically complex children in reducing care days outside the home (clinic, emergency department, or hospital; primary outcome), rate of children developing serious illnesses (causing death, ICU admission, or hospital stay >7 days), and health system costs. We used intent-to-treat Bayesian analyses with neutral prior assuming no benefit. All participants received CC, which included 24/7 phone access to primary care providers (PCPs), low patient-to-PCP ratio, and hospital consultation from PCPs. The telemedicine group also received remote audiovisual communication with the PCPs.
Results:
Between August 22, 2018, and March 23, 2020, we randomly assigned 422 medically complex children (209 to CC with telemedicine and 213 to CC alone) before meeting predefined stopping rules. The probability of a reduction with CC with telemedicine versus CC alone was 99% for care days outside the home (12.94 vs 16.94 per child-year; Bayesian rate ratio, 0.80 [95% credible interval, 0.66-0.98]), 95% for rate of children with a serious illness (0.29 vs 0.62 per child-year; rate ratio, 0.68 [0.43-1.07]) and 91% for mean total health system costs (US$33 718 vs US$41 281 per child-year; Bayesian cost ratio, 0.85 [0.67-1.08]).
Conclusion:
The addition of telemedicine to CC likely reduced care days outside the home, serious illnesses, other adverse outcomes, and health care costs for medically complex children.
