title: Effectiveness and Safety of Acute Care Telemedicine for Children with Regular and Special Healthcare Needs.
abstract: OBJECTIVE
  To assess the hypothesis that effectiveness and safety of the Health-e-Access telemedicine model for care of children with special healthcare needs (CSHCN) with acute illness equaled those for care of children in regular childcare and schools (CRS).
  
  
  METHODS
  We examined healthcare use through insurance claims and telemedicine records spanning 5.7 and 7.3 years for CSHCN and CRS, respectively. Effectiveness was measured as telemedicine visit completion, duplication, and adverse events. Completed visits had diagnosis and management decisions made, and treatment implemented, based solely on telemedicine. Duplicating visits addressed related problems in-person following telemedicine visits within 1 or 3 days. An adverse event was defined as an emergency department visit following a telemedicine visit within 3 days for a problem probably related.
  
  
  RESULTS
  Comparisons addressing these measures included 483 and 10,008 telemedicine visits by CSHCN and CRS, respectively. Claims files captured health services use for varying periods of time among 300 different CSHCN and among 1,950 different CRS. Among the 483 telemedicine visits initiated for CSHCN over their telemedicine observation period, 9 were not completed. The CSHCN completion rate of 98.1% equaled the 97.6% completion observed among CRS. Within 3 days, in-person visits duplicated 16.1% of telemedicine visits for both CSHCN and CRS. Within 1 day, in-person visits duplicated 5.3% and 8.9% of telemedicine visits for CSHCN and CRS, respectively. Adverse events following telemedicine visits included 0.3% of telemedicine visits for CSHCN and 0.5% for CRS.
  
  
  CONCLUSIONS
  Observations support safety and effectiveness of Health-e-Access telemedicine for both CSHCN and CRS.
authors.affiliation: 1 Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center , Rochester, New York.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: McConnochie
authors.affiliation: 1 Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center , Rochester, New York.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Ronis
authors.affiliation: 2 Department of Emergency Medicine, University of Rochester Medical Center , Rochester, New York.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Wood
authors.affiliation: 3 Information Services Division, University of Rochester Medical Center , Rochester, New York.
authors.forename: Phillip K
authors.initials: PK
authors.lastname: Ng
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D017146:Models, Organizational; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D017216:Telemedicine / Q000458:organization & administration*
keywords: children with special healthcare needs; effectiveness; pediatrics; safety; telemedicine; urban