title: Patient evaluation of an acute care pediatric telemedicine service in urban neighborhoods.
abstract: BACKGROUND
  Telemedicine has enhanced care for children with illness in Rochester, NY, since May 2001, enabling 13,568 acute illness visits through December 2013. Prior findings included high parent satisfaction with childcare- and school-based telemedicine ("school telemedicine") and potential to replace 85% of office visits for illness. Urban neighborhood telemedicine ("neighborhood telemedicine") was designed to offer convenient care for illness episodes that school telemedicine often cannot serve because illness arises when children are at home or symptoms preclude attendance. This study was designed to characterize health problems prompting neighborhood telemedicine use and to assess parent perceptions of its value.
  
  
  METHODS
  A parent satisfaction instrument was developed with input from parents and providers. Neighborhood telemedicine was initiated in January 2009 and totaled 1,362 visits through November 2013. During a 29-month survey period through January 2012, 3,871 acute illness telemedicine visits were completed, 908 (23.5%) of them via neighborhood telemedicine. Instruments were completed for 392 (43.2%) of the 908 visits.
  
  
  RESULTS
  Neighborhood telemedicine comprised 27% of all telemedicine visits during the year of peak neighborhood activity. Almost all survey respondents were satisfied or highly satisfied with neighborhood visits (97.6%) and endorsed greater convenience than alternatives (94.5%).
  
  
  CONCLUSIONS
  Family preferences and the high value placed on neighborhood telemedicine suggest such service is important, especially in health systems driven by patient values. Service provided by neighborhood telemedicine holds potential to meet a large demand for care of acute childhood illness. Financing reform to support patient-centered care (e.g., bundled payments) should encompass sustainable business models for this service.
authors.affiliation: 1 Division of Social and Behavioral Sciences, Department of Public Health Sciences, University of Rochester Medical Center , Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McIntosh
authors.forename: Dominic
authors.initials: D
authors.lastname: Cirillo
authors.forename: Nancy
authors.initials: N
authors.lastname: Wood
authors.forename: Ann M
authors.initials: AM
authors.lastname: Dozier
authors.forename: Carol
authors.initials: C
authors.lastname: Alarie
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: McConnochie
mesh_terms: D002648:Child; D002662:Child Health Services; D019538:Health Care Surveys; D006801:Humans; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D017216:Telemedicine; D019037:Urban Health Services
keywords: e-health; pediatrics; telehealth; telemedicine