Use of telemedicine to provide pediatric critical care inpatient consultations to underserved rural Northern California.
OBJECTIVE
To report a novel application of telemedicine and to assess the resulting quality and satisfaction of care. Study design An existing telemedicine program was evaluated through the use of a nonconcurrent cohort design. Cohorts of patients were compared by means of the Pediatric Risk of Mortality, version III (PRISM III), to adjust for severity of illness and assess risk-adjusted mortality rates. Satisfaction and quality of care surveys administered to the pediatric patient's parents and providers were also analyzed.


RESULTS
Telemedicine consultations (n=70) were conducted on 47 patients during a 2-year period. Patients receiving telemedicine consultations were sicker than the average pediatric patient cared for in the adult intensive care unit (ICU) (n=180) and compared with historic control pediatric patients (n=116) (mean PRISM III score of 9.6 versus 7.7 and 7.5, respectively). PRISM III-standardized mortality ratios were consistent among the same cohorts of patients (0.24, 0.36, and 0.37, respectively). Overall satisfaction and perception of quality of care was high among parents and rural health care providers.


CONCLUSIONS
This study demonstrates that a regional pediatric ICU-based telemedicine program providing live interactive consultations to a rural adult ICU can provide quality care that is considered highly satisfactory to a select group of critically ill pediatric patients.
Marcin
James P
JP
Department of Pediatrics and Center for Health and Technology, University of California, Davis, and the Mercy Medical Center Redding, Redding, California 95817, USA. jpmarcin@ucdavis.edu
Nesbitt
Thomas S
TS
Kallas
Harry J
HJ
Struve
Steven N
SN
Traugott
Craig A
CA
Dimand
Robert J
RJ
D002140:California; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D008507:Medically Underserved Area; D017060:Patient Satisfaction; D010372:Pediatrics / Q000379:methods; D011787:Quality of Health Care; D019114:Remote Consultation; D012423:Rural Health; D019035:Rural Health Services