Recently, researchers in Queensland, Australia performed a retrospective review of pediatric orthopedic surgery telemedicine visits conducted by the Royal Children’s Hospital from January 2004 to September 2012. This was done to help define the impact of these services and find opportunities to better utilize limited resources in the delivery of telehealth in general.
The study sought to determine who used the service, the conditions of patients using this service, and the outcomes of these patients. The long term goal of the study was to determine how the limited telemedicine resources could be better utilized to address disparities in access to health care that exist between rural and urban regions in Australia, with obvious implications for other regions of the world.
In this study of 126 patient records, one of the most important findings was that children with known disabilities made up a large percentage of the patients using the telemedicine service. 40% of the patients had documented cerebral palsy. Its unclear how that compares to the demographics of all of the patients presenting to this clinic i.e. whether 40% of all patients have CP in that clinic or whether the telemedicine practice is truly enriched for CP patients.
The investigators speculated that the costs and difficulty in transporting patients with disabilities may have been a key factor leading to this finding. Because of the equipment that is often involved with this group of patients and potential behavioral difficulties making transportation difficult, its possible the costs of transport are much greater for this group and that parents are likely to opt out of taking them to a physician when a telemedicine option is available.
Another important finding was the list of conditions that resulted in a telemedicine visit. There was a fairly wide distribution of conditions, but the bulk of them (103 of 126) fall into the category of lower limb complaints. The top primary diagnoses were categorized as:
- other lower limb pathology
- tone/spasticity
- upper limb (congenital radial head dislocation, fibrous dysplasia)
- developmental dysplasia of the hip
- increased tibial torsion and/or increased femoral neck anteversion
- hands (clinodactyly, camptodactyly, hypoplastic thumbs, syndactyly)
The third important finding was the outcomes of the visits. The majority of patients, 50 of 126, were seen without any evidence in their records that they required a face-to-face interaction to resolve their problem. The telehealth visit appeared to be sufficient for the needs of these patients. 28 of 126 were referred for a consultation and eventually had surgery. 23 of 126 had additional telehealth review, but no referral after that.
This study provides useful information to health systems who may be considering developing a remote surgical consultation program. Developing programs that are in tune with the needs of parents of disabled children with orthopedic conditions may be a good use of resources for programs of this nature. It also highlights an alternative approach to payer decision-making about telehealth — rather than focusing purely on the local availability of healthcare, perhaps we should be thinking more about the patient-factors that may make telehealth services more economical, more practical, and more effective.
