title: Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals.
abstract: OBJECTIVE
  Although there is growing evidence regarding the utility of telemedicine in providing care for acutely ill children in underserved settings, adoption of pediatric emergency telemedicine remains limited, and little data exist to inform implementation efforts. Among clinician stakeholders, we examined attitudes regarding pediatric emergency telemedicine, including barriers to adoption in rural settings and potential strategies to overcome these barriers.
  
  
  METHODS
  Using a sequential mixed-methods approach, we first performed semistructured interviews with clinician stakeholders using thematic content analysis to generate a conceptual model for pediatric emergency telemedicine adoption. Based on this model, we then developed and fielded a survey to further examine attitudes regarding barriers to adoption and strategies to improve adoption.
  
  
  RESULTS
  Factors influencing adoption of pediatric emergency telemedicine were identified and categorized into 3 domains: contextual factors (such as regional geography, hospital culture, and individual experience), perceived usefulness of pediatric emergency telemedicine, and perceived ease of use of pediatric emergency telemedicine. Within the domains of perceived usefulness and perceived ease of use, belief in the relative advantage of telemedicine was the most pronounced difference between telemedicine proponents and nonproponents. Strategies identified to improve adoption of telemedicine included patient-specific education, clinical protocols for use, decreasing response times, and simplifying the technology.
  
  
  CONCLUSIONS
  More effective adoption of pediatric emergency telemedicine among clinicians will require addressing perceived usefulness and perceived ease of use in the context of local factors. Future studies should examine the impact of specific identified strategies on adoption of pediatric emergency telemedicine and patient outcomes in rural settings.
authors.affiliation: From the *Division of General Academic Pediatrics, Department of Pediatrics, †Division of Pediatric Critical Care Medicine, Departments of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, ‡Department of Critical Care Medicine, §Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, ∥Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, and ¶Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Kristin N
authors.initials: KN
authors.lastname: Ray
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Felmet
authors.forename: Melinda F
authors.initials: MF
authors.lastname: Hamilton
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Kuza
authors.forename: Richard A
authors.initials: RA
authors.lastname: Saladino
authors.forename: Brian R
authors.initials: BR
authors.lastname: Schultz
authors.forename: R Scott
authors.initials: RS
authors.lastname: Watson
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
mesh_terms: D002648:Child; D004635:Emergency Medicine / Q000379:methods*; D006780:Hospitals, Rural; D006801:Humans; D036301:Qualitative Research; D012424:Rural Population; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods / Q000706:statistics & numerical data*