title: Acute illness care patterns change with use of telemedicine.
abstract: OBJECTIVE
  Health-e-Access, a telemedicine service providing care for acute illnesses in children, has delivered >6500 telemedicine visits from 10 primary care practices in Rochester, New York, by using telemedicine access at 22 child care and school sites. The goal was to assess the hypotheses that children served by Health-e-Access received health care more often for acute illnesses but had fewer emergency department (ED) visits and lower health care expenditures than did children without access through this service.
  
  
  METHODS
  By using insurance claims, this case study compared utilization (starting in May 2001) of telemedicine, office, or ED care for children with versus without telemedicine access. Children included in analyses had > or =6 consecutive insurance-covered months through July 2007. Claims data captured all utilization. A total of 19 652 child-months from 1216 children with telemedicine access were matched with respect to age, gender, socioeconomic status, and season with child-months for children without telemedicine availability.
  
  
  RESULTS
  The mean age at utilization was 6.71 years, with 79% of all child-months being covered by Medicaid managed care. The overall utilization rate was 305.1 visits per 100 child-years. In multivariate analyses with adjustment for potential confounders, overall illness-related utilization rates (in-person or telemedicine visits per 100 child-years) for all sites were 23.5% greater for children with telemedicine access than for control children, but ED utilization was 22.2% less.
  
  
  CONCLUSIONS
  The Health-e-Access telemedicine model holds potential to reduce health care costs, mostly through replacement of ED visits for nonemergency problems.
authors.affiliation: Department of Pediatrics, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA. ken_mcconnochie@urmc.rochester.edu
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: McConnochie
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Wood
authors.forename: Neil E
authors.initials: NE
authors.lastname: Herendeen
authors.forename: Phillip K
authors.initials: PK
authors.lastname: Ng
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Roghmann
mesh_terms: D000208:Acute Disease / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data; D009518:New York; D011320:Primary Health Care; D019114:Remote Consultation / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data