IMPACT OF SCHOOL TELEHEALTH ON ACCESS TO MEDICAL CARE, CLINICAL OUTCOMES, AND COST SAVINGS AMONG CHILDREN IN RURAL ARKANSAS.

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Title:	IMPACT OF SCHOOL TELEHEALTH ON ACCESS TO MEDICAL CARE, CLINICAL OUTCOMES, AND COST SAVINGS AMONG CHILDREN IN RURAL ARKANSAS.
Authors:	Bynum, Ann B.^1,2,3 bynumcarola@uams.edu, Irwin, Cathy A.², Burke, Bryan L.⁴, Hadleys, Matthew V.⁵, Vogels, Ralph⁵, Evans, Patrick⁶, Ragland, Denise⁷, Johnson, Tina²
Source:	Journal of Education Research. 2011, Vol. 5 Issue 2, p99-117. 19p.
Subject Terms:	Health services accessibility, School health services, Health outcome assessment, Medical care cost control, Telemedicine, Medical consultation
Geographic Terms:	Arkansas
Abstract:	Purpose: This study evaluated access to medical care, changes in clinical outcomes, and cost savings among children participating in telehealth/telemedicine consultations, asthma and diabetes telemonitoring consultations in a school telehealth project in rural Arkansas. Methods: A one-group pretest; 3-month, 6-month, and 12-month follow-up design was used with a sample of 56 elementary, middle, and high school children and adolescents in the University of Arkansas for Medical Sciences (UAMS), Center for Distance Health, Telehealth KIDS project during August, 2007-August, 2009. This project provided telehealth consultations in 2 elementary schools, 1 middle school, and 1 high school in rural Arkansas. The telehealth/telemedicine consultations used interactive video technology to provide medical management and self-management education for asthma, diabetes, and acute pediatric conditions. Telemonitoring consultations at the schools assessed peak expiratory flow (PEF) and forced expiratory volume (FEV1) (measures of lung function); pulse oximetry (measure of oxygen saturation); blood glucose; blood pressure; heart rate; asthma and diabetes symptoms. Statistical procedures included the longitudinal data analysis, McNemar test, Wilcoxon signed ranks test, and paired samples t-test. Findings: This project provided 3,135 telehealth consultations, which included 2,583 asthma consultations (n = 40 children/adolescents) for telemonitoring, inhaler assessments/education, spirometry lung function testing, and asthma education; 546 diabetes consultations (n = 6 children/adolescents) for telemonitoring and diabetes education; and 6 telehealth/telemedicine consultations for acute pediatric conditions. During 2007-2008, children were referred to the Pediatric Nurse Practitioner in this project during 2,625 (84%) telehealth consultations; and during 875 (28%) consultations at 12-month follow-up. During 2007-2008, a referral to additional health resources in this project was made for children and families during 1,939 (62%) telehealth consultations; and during 1,309 (42%) consultations at 12-month follow-up. Children with asthma had decreased hospital admissions from baseline (mean = 0.20) to 12-month follow-up (mean = 0.00), with total cost savings of $2,526.00 in Medicaid reimbursement costs. These children had fewer school absences and asthma-symptom days from baseline (respectively, mean = 4.33, mean = 3.26) to 12-month follow-up (respectively, mean = 2.87, mean = 1.33); and demonstrated significantly improved inhaler technique from baseline to 15-month follow-up (P < .01). Children with diabetes had decreased blood glucose and improved adherence to daily glucose monitoring from baseline (respectively, mean = 285.17, 50%) to 6-month follow-up (respectively, mean = 209.83,100%). Conclusion: School telehealth improved access to health care for children in the rural Arkansas Delta and demonstrated positive clinical outcomes and cost savings in Medicaid reimbursement costs. [ABSTRACT FROM AUTHOR]
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Database:	Education Research Complete

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Abstract:	Purpose: This study evaluated access to medical care, changes in clinical outcomes, and cost savings among children participating in telehealth/telemedicine consultations, asthma and diabetes telemonitoring consultations in a school telehealth project in rural Arkansas. Methods: A one-group pretest; 3-month, 6-month, and 12-month follow-up design was used with a sample of 56 elementary, middle, and high school children and adolescents in the University of Arkansas for Medical Sciences (UAMS), Center for Distance Health, Telehealth KIDS project during August, 2007-August, 2009. This project provided telehealth consultations in 2 elementary schools, 1 middle school, and 1 high school in rural Arkansas. The telehealth/telemedicine consultations used interactive video technology to provide medical management and self-management education for asthma, diabetes, and acute pediatric conditions. Telemonitoring consultations at the schools assessed peak expiratory flow (PEF) and forced expiratory volume (FEV1) (measures of lung function); pulse oximetry (measure of oxygen saturation); blood glucose; blood pressure; heart rate; asthma and diabetes symptoms. Statistical procedures included the longitudinal data analysis, McNemar test, Wilcoxon signed ranks test, and paired samples t-test. Findings: This project provided 3,135 telehealth consultations, which included 2,583 asthma consultations (n = 40 children/adolescents) for telemonitoring, inhaler assessments/education, spirometry lung function testing, and asthma education; 546 diabetes consultations (n = 6 children/adolescents) for telemonitoring and diabetes education; and 6 telehealth/telemedicine consultations for acute pediatric conditions. During 2007-2008, children were referred to the Pediatric Nurse Practitioner in this project during 2,625 (84%) telehealth consultations; and during 875 (28%) consultations at 12-month follow-up. During 2007-2008, a referral to additional health resources in this project was made for children and families during 1,939 (62%) telehealth consultations; and during 1,309 (42%) consultations at 12-month follow-up. Children with asthma had decreased hospital admissions from baseline (mean = 0.20) to 12-month follow-up (mean = 0.00), with total cost savings of $2,526.00 in Medicaid reimbursement costs. These children had fewer school absences and asthma-symptom days from baseline (respectively, mean = 4.33, mean = 3.26) to 12-month follow-up (respectively, mean = 2.87, mean = 1.33); and demonstrated significantly improved inhaler technique from baseline to 15-month follow-up (P < .01). Children with diabetes had decreased blood glucose and improved adherence to daily glucose monitoring from baseline (respectively, mean = 285.17, 50%) to 6-month follow-up (respectively, mean = 209.83,100%). Conclusion: School telehealth improved access to health care for children in the rural Arkansas Delta and demonstrated positive clinical outcomes and cost savings in Medicaid reimbursement costs. [ABSTRACT FROM AUTHOR]
ISSN:	1935052X