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  1. Article ; Online: The role of increasing synchronous telehealth use during the COVID-19 pandemic on disparities in access to healthcare: A systematic review.

    Ternes, Sara / Lavin, Lauren / Vakkalanka, J Priyanka / Healy, Heather S / Merchant, Kimberly As / Ward, Marcia M / Mohr, Nicholas M

    Journal of telemedicine and telecare

    2024  , Page(s) 1357633X241245459

    Abstract: Introduction: The COVID-19 public health emergency led to an unprecedented rapid increase in telehealth use, but the role of telehealth in reducing disparities in access to care has been questioned. The objective of this study was to conduct a ... ...

    Abstract Introduction: The COVID-19 public health emergency led to an unprecedented rapid increase in telehealth use, but the role of telehealth in reducing disparities in access to care has been questioned. The objective of this study was to conduct a systematic review to summarize the available evidence on how telehealth during the COVID-19 pandemic was associated with telehealth utilization for minority groups and its role in health disparities.
    Methods: We conducted a systematic review focused on health equity and access to care by searching for interventional and observational studies using the following four search domains: telehealth, COVID-19, health equity, and access to care. We searched PubMed, Embase, Cochrane CENTRAL, CINAHL, telehealth.hhs.gov, and the Rural Health Research Gateway, and included any study that reported quantitative results with a control group.
    Results: Our initial search yielded 1970 studies, and we included 48 in our final review. The most common dimensions of health equity studied were race/ethnicity, rurality, insurance status, language, and socioeconomic status, and the telehealth applications studied were diverse. Included studies had a moderate risk of bias. In aggregate, most studies reported increased telehealth use during the pandemic, with the greatest increase in non-minority populations, including White, younger, English-speaking people from urban areas.
    Discussion: We found that despite rapid adoption and increased telehealth use during the public health emergency, telehealth did not reduce existing disparities in access to care. We recommend that future work measuring the impact of telehealth focus on equity so that features of telehealth innovation can reduce disparities in health outcomes.
    Language English
    Publishing date 2024-04-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 1340281-x
    ISSN 1758-1109 ; 1357-633X
    ISSN (online) 1758-1109
    ISSN 1357-633X
    DOI 10.1177/1357633X241245459
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

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  2. Article ; Online: Tele-emergency behavioural health in rural and underserved areas.

    Weigel, Paula / Bhagianadh, Divya / Merchant, Kimberly As / Wittrock, Amy / Rahmouni, Hicham / Bell, Amanda / Laws, Stephanie / Ward, Marcia M

    Journal of telemedicine and telecare

    2019  Volume 27, Issue 7, Page(s) 453–462

    Abstract: Introduction: Challenges accessing behavioural health services in rural and underserved areas are compounded by severe shortages of behavioural health specialists, and difficulties placing patients. Tele-emergency (tele-ED) behavioural health is a ... ...

    Abstract Introduction: Challenges accessing behavioural health services in rural and underserved areas are compounded by severe shortages of behavioural health specialists, and difficulties placing patients. Tele-emergency (tele-ED) behavioural health is a promising solution for enhancing access to specialists and assisting in patient placement. This paper describes two tele-ED behavioural health models in the Midwest delivering mental- and substance use disorder services to rural and underserved adult populations.
    Methods: We performed an in-depth examination of two tele-ED behavioural health programmes and their consultation processes. We provide a retrospective case-control analysis of patient characteristics, patient diagnoses, and disposition status for each model. Data were collected from 19 spoke hospitals across the two programmes between November 2015 and December 2017.
    Results: Tele-ED was activated in 15% of the Avera Health sample and 58% of the Union Hospital sample. This is primarily a reflection of the sample selection process in each model and how each programme is operationalised. Suicide and/or poisoning by drugs were the most frequent diagnoses followed by mood disorders. Rate of transfer to another inpatient facility was much higher for tele-ED cases than controls in both models.
    Discussion: This paper describes how two distinct tele-ED behavioural health models operating in unique contexts address challenges in access and placement for patients in rural and underserved areas presenting to EDs with behavioural health conditions. The notable difference in disposition rates between cases and controls is indicative of the impact each model is having on care practices and processes.
    MeSH term(s) Adult ; Emergency Service, Hospital ; Humans ; Medically Underserved Area ; Retrospective Studies ; Rural Population ; Telemedicine
    Language English
    Publishing date 2019-11-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 1340281-x
    ISSN 1758-1109 ; 1357-633X
    ISSN (online) 1758-1109
    ISSN 1357-633X
    DOI 10.1177/1357633X19887027
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 4525: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.

    Mohr, Nicholas M / Schuette, Allison R / Ullrich, Fred / Mack, Luke J / DeJong, Katie / Camargo, Carlos A / Zachrison, Kori S / Boggs, Krislyn M / Skibbe, Adam / Bell, Amanda / Pals, Mark / Shane, Dan M / Carter, Knute D / Merchant, Kimberly As / Ward, Marcia M

    Journal of comparative effectiveness research

    2022  Volume 11, Issue 10, Page(s) 703–716

    Abstract: Aim: ...

    Abstract Aim:
    MeSH term(s) Aged ; Emergency Service, Hospital ; Humans ; Medicare ; Outcome Assessment, Health Care ; Sepsis/therapy ; Telemedicine ; United States
    Language English
    Publishing date 2022-05-24
    Publishing country England
    Document type Clinical Study ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 2669725-7
    ISSN 2042-6313 ; 2042-6305
    ISSN (online) 2042-6313
    ISSN 2042-6305
    DOI 10.2217/cer-2022-0019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Paediatric tele-emergency care: A study of two delivery models.

    Weigel, Paula A / Merchant, Kimberly As / Wittrock, Amy / Kissee, Jamie / Ullrich, Fred / Bell, Amanda L / Marcin, James P / Ward, Marcia M

    Journal of telemedicine and telecare

    2019  Volume 27, Issue 1, Page(s) 23–31

    Abstract: Introduction: Tele-emergency models have been utilized for decades, with growing evidence of their effectiveness. Due to the variety of tele-emergency department (tele-ED) models used in practice, however, it is challenging to build standardized metrics ...

    Abstract Introduction: Tele-emergency models have been utilized for decades, with growing evidence of their effectiveness. Due to the variety of tele-emergency department (tele-ED) models used in practice, however, it is challenging to build standardized metrics for ongoing evaluation. This study describes two tele-ED programs, one specialized and one general, that provide care to paediatric populations. Through an examination of model structures and patient populations, we gain insight into how evaluative measures should reflect tele-ED model design and purpose.
    Methods: Qualitative descriptions of the two tele-ED models are presented. We show a retrospective cohort analysis describing paediatric patients' key characteristics, reasons for visit, and disposition status by case/control status. Case/control patient encounter data were collected October 2015 through December 2017, from 15 spoke hospitals within each tele-ED program.
    Results: The two tele-ED models serve distinct paediatric populations, and measures of tele-ED utilization and disposition reflect those differences. In the specialized University of California (UC) Davis Health program, tele-ED was utilized in 36% of paediatric critical care encounters and 78% of those were transferred. In the Avera eCARE program, tele-ED was activated in 1.7% of paediatric encounters and 50.6% of those were transferred. When Avera eCARE paediatric encounters were stratified by severity, measures of tele-ED use and disposition status among high-severity encounters were more similar to UC Davis Health.
    Discussion: This study describes how design choices of tele-ED models have implications for evaluative measures. Measures of tele-ED model success need to reflect model purpose, populations served, and for whom tele-ED service use is appropriate.
    MeSH term(s) Adolescent ; California ; Child ; Child, Preschool ; Critical Care/methods ; Delivery of Health Care/methods ; Emergency Medical Services ; Emergency Service, Hospital ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Models, Theoretical ; Pediatric Emergency Medicine/methods ; Program Evaluation ; Retrospective Studies ; South Dakota ; Telemedicine/methods
    Language English
    Publishing date 2019-04-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 1340281-x
    ISSN 1758-1109 ; 1357-633X
    ISSN (online) 1758-1109
    ISSN 1357-633X
    DOI 10.1177/1357633X19839610
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 4525: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.

    Swanson, Morgan B / Miller, Aspen C / Ward, Marcia M / Ullrich, Fred / Merchant, Kimberly As / Mohr, Nicholas M

    Journal of telemedicine and telecare

    2019  Volume 27, Issue 6, Page(s) 343–352

    Abstract: Introduction: Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (a) identify the impact of ...

    Abstract Introduction: Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (a) identify the impact of telemedicine on emergency department (ED) stroke care, (b) identify if telemedicine impact varied by network and (c) describe the variation in process outcomes by telemedicine across EDs.
    Methods: A prospective cohort study identified stroke patients in four telemedicine networks between November 2015 and December 2017. Primary exposure was telemedicine consultation during ED evaluation. Outcomes included: (a) interpretation of computed tomography (CT) of the head within 45 minutes and (b) time to administer tissue plasminogen activator (tPA). An interaction term tested for differences in telemedicine effect on stroke care by network and hospital.
    Results: Of the 932 stroke subjects, 36% received telemedicine consults. For subjects with a last known well time within two hours of ED arrival (27.9%), recommended CT interpretation within 45 minutes was met for 66.8%. Telemedicine was associated with higher odds of timely head CT interpretation (adjusted odds ratio = 3.03; 95% confidence interval (CI) 1.69-5.46). The magnitude of the association between telemedicine and time to interpret a CT of the head differed between telemedicine networks (interaction term
    Discussion: Telemedicine consultation during the ED encounter decreased the time to interpret at CT of the head among stroke patients, with differing magnitudes of benefit across telemedicine networks. The effect of heterogeneity of telestroke affects across different networks should be explored in future analyses.
    MeSH term(s) Cohort Studies ; Emergency Service, Hospital ; Fibrinolytic Agents/therapeutic use ; Humans ; Prospective Studies ; Referral and Consultation ; Stroke/drug therapy ; Stroke/therapy ; Telemedicine ; Thrombolytic Therapy ; Time Factors ; Tissue Plasminogen Activator/therapeutic use ; Tomography, X-Ray Computed
    Chemical Substances Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
    Language English
    Publishing date 2019-11-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 1340281-x
    ISSN 1758-1109 ; 1357-633X
    ISSN (online) 1758-1109
    ISSN 1357-633X
    DOI 10.1177/1357633X19877746
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 4525: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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