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Telemedicine in pediatric and perinatal cardiology: Economic evaluation of a service in English hospitals

Published online by Cambridge University Press:  18 January 2007

Robin Dowie ,
Hema Mistry ,
Tracey A. Young ,
Gwyn C. Weatherburn ,
Helena M. Gardiner ,
Michael Rigby ,
Giselle V. Rowlinson  and
Rodney C. G. Franklin
Robin Dowie
Affiliation:
Brunel University
Hema Mistry
Affiliation:
Brunel University
Tracey A. Young
Affiliation:
University of Sheffield
Gwyn C. Weatherburn
Affiliation:
Buckinghamshire Chilterns University College
Helena M. Gardiner
Affiliation:
Imperial CollegeandRoyal Brompton & Harefield NHS Trust
Michael Rigby
Affiliation:
Imperial CollegeandRoyal Brompton & Harefield NHS Trust
Giselle V. Rowlinson
Affiliation:
Royal Brompton & Harefield NHS Trust
Rodney C. G. Franklin
Affiliation:
National Heart & Lung InstituteandRoyal Brompton & Harefield NHS Trust
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Abstract

Objectives: Pediatric cardiology has an expanding role in fetal and pediatric screening. The aims of this study were to observe how district hospitals use a pediatric telecardiology service, and to compare the costs and outcomes of patients referred to specialists by means of this service or conventionally.

Methods: A telemedicine service was set up between a pediatric cardiac center in London and four district hospitals for referrals of second trimester women, newborn babies, and older children. Clinicians in each hospital decided on the role for their service. Clinical events were audited prospectively and costed, and patient surveys were conducted.

Results: The hospitals differed in their selection of patient groups for the service. In all, 117 telemedicine patients were compared with 387 patients seen in London or in outreach clinics. Patients selected for telemedicine were generally healthier. For all patients, the mean cost for the initial consultation was £411 for tele-referrals and £277 for conventional referrals, a nonsignificant difference. Teleconsultations for women and children were significantly more expensive because of technology costs, whereas for babies, ambulance transfers were much more costly. After 6-months follow-up, the difference between referral methods for all patients was nonsignificant (telemedicine, £3,350; conventional referrals, £2,172), and nonsignificant within the patient groups.

Conclusions: Telemedicine was perceived by cardiologists, district clinicians, and families as reliable and efficient. The equivocal 6-month cost results indicate that investment in the technology is warranted to enhance pediatric and perinatal cardiology services.

Keywords

Costs and cost analysisHeart defectsCongenitalOutpatientsPerinatal careTelemedicine
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 1 , January 2007 , pp. 116 - 125
Copyright
© 2007 Cambridge University Press

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References

Automobile Association website. 2003. Petrol car running costs. Available at: www.theaa.com/allaboutcars/advice/advice_rcosts_home.html. Accessed March 13
Belmont JM, Mattioli LF, Goertz KK, Ardinger RH Jr, Thomas CM. 1995 Evaluation of remote stethoscopy for pediatric telecardiology. Telemed J. 1: 133– 149.Google Scholar
British Association of Perinatal Medicine. 2001. Standards for hospitals providing neonatal intensive and high dependency care. 2nd ed. London: British Association of Perinatal Medicine;
Brooks R. 1996 EuroQol: The current state of play. Health Policy. 37: 53– 72.Google Scholar
Casey F, Brown D, Craig BG, Rogers J, Mulholland HC. 1996 Diagnosis of neonatal congenital heart defects by remote consultation using a low-cost telemedicine link. J Telemed Telecare. 2: 165– 169.Google Scholar
Department of Health. 2002. Advanced letter (MD) 1/02: Pay and conditions of service of hospital medical and dental staff and doctors in public health medicine and the community health service. London: DoH;
Department of Health. 2002. Advanced letter (NM) 1/2002: Nurses' and midwives' pay for 2002/03. London: DoH;
Department of Health. 2002. Advanced letter (PTA) 1/2002: Professions allied to medicine and related grades of staff–pay for 2002/2003. London: DoH;
Finley JP, Sharratt GP, Nanton MA, et al. 1997 Paediatric echocardiography by telemedicine–nine years' experience. J Telemed Telecare. 3: 200– 204.Google Scholar
Fisk NM, Sepulveda W, Drysdale K, et al. 1996 Fetal telemedicine: Six month pilot of real-time ultrasound and video consultation between the Isle of Wight and London. Br J Obstet Gynaecol. 103: 1092– 1095.Google Scholar
Gardiner HM. 2001 Access to perinatal cardiology in the United Kingdom. Postgrad Med J. 77: 1– 3.Google Scholar
Hailey D, Ohinmaa A, Roine R. 2004. Evidence for the benefits of telecardiology applications: A systematic review. Edmonton: Alberta Heritage Foundation for Medical Research;
Hersh WR, Wallace JA, Patterson PK, et al. 2001. Telemedicine for the Medicare population: Pediatric, obstetric and clinician-indirect home interventions. Evidence Report/Technology Assessment: Number 24, Supplement. (AHRQ Publication No. 01-E060). Rockville: Agency for Healthcare Research and Quality; Available at: www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.34386.
HM Treasury. 2003. The Green Book: Appraisal and evaluation in central government. London: The Stationery Office; Available at: www.hm-treasury.gov.uk/media//05553/Green_ Book_03.pd.
Jacklin PB, Roberts JA, Wallace P, et al. 2003 Virtual outreach: Economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion. BMJ. 327: 84– 88.Google Scholar
Leslie A, Stephenson T. 2003 Neonatal transfers by advanced neonatal nurse practitioners and paediatric registrars. Arch Dis Child Fetal Neonatal Ed. 88: F509– F512.Google Scholar
Longworth L, Young T, Buxton MJ, et al. 2003 Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups. Liver Transpl. 9: 1295– 1307.Google Scholar
Manificat S, Dazord A, Langue J, et al. 1999 A new instrument to evaluate infant quality of life. QoL Newsletter. 23: 7– 8.Google Scholar
Manificat S, Dazord A, Langue J, et al. 2000 Évaluation de la qualité de vie du nourrisson et du très jeune enfant: Validation d'un questionnaire. Étude multicentrique européenne. Arch Pédiatr. 7: 605– 614.Google Scholar
Manly BFJ. 1997. Randomisation, bootstrap and Monte Carlo methods in biology. 2nd ed. London: Chapman & Hall Texts in Statistical Science;
Maynard L, Franklin RCG, Wray J. 2005 A survey of professionals delivering secondary care regarding their requirements for paediatric cardiac services as provided by specialists. Cardiol Young. 15: 489– 492.Google Scholar
Multimap. Multimap Com. London; 2003. Available at: www.multimap.com/.
Murugan SJ, Thompson J, Parsons JM, et al. 2005 New outpatient referrals to a tertiary paediatric cardiac centre: Evidence of increasing workload and evolving patterns of referral. Cardiol Young. 15: 43– 46.Google Scholar
Netten A, Curtis L. 2002. Unit costs of health and social care 2002. Canterbury: University of Kent at Canterbury, Personal Social Services Research Unit;
NHS Executive. 1998. Information for health: An information strategy for the modern NHS 1998-2005. Leeds: NHS Executive;
Nitzkin JL, Zhu N, Marier RL. 1997 Reliability of telemedicine examination. Telemed J. 3: 141– 157.Google Scholar
Petersen S, Peto V, Rayner M. 2003. Congenital heart disease statistics 2003. Oxford: University of Oxford, British Heart Foundation Health Promotion Research Group, Department of Public Health; Available at: www.heartstats.org/uploads/documents%5CCoHDstatistics.pdf.
S-PLUS. 2000. Guide to statistics, volumes 1 and 2. Seattle, WA: Mathsoft;
StataCorp. 2003. Stata statistical software: Release 8.0. College Station, TX: Stata Corporation;
Tsilimigaki A, Maraka S, Tsekoura T, et al. 2001 Eighteen months' experience with remote diagnosis, management and education in congenital heart disease. J Telemed Telecare. 7: 239– 243.Google Scholar
Varni JW, Seid M, Kurtin PS. 2001 PedsQL™ 4.0: Reliability and validity of the Pediatric Quality of Life Inventory™ version 4.0 generic core scales in healthy and patient populations. Med Care. 39: 800– 812.Google Scholar
Varni JW, Burwinkle T, Seid M, Zellner J. 2002 The PedsQL™ as a population health measure: Implications for states and nations. QoL Newsletter. 28: 4– 6.Google Scholar
Wagstaff MH, Rigby ML, Redington AN. 1998 Increasing workload and changing referral patterns in paediatric cardiology outreach clinics: Implications for consultant staffing. Heart. 79: 223– 224.Google Scholar
Wallace P, Barber J, Clayton W, et al. 2004 Virtual outreach: A randomised controlled trial and economic evaluation of joint teleconferenced medical consultations. Health Technol Assess. 8 (50): 1– 106.Google Scholar
Weatherburn G, Dowie R, Mistry H, Young T. 2006: An assessment of parental satisfaction with mode of delivery of specialist advice for pediatric cardiology: Face-to-face versus teleconference. J Telemed Telecare. 12 (Suppl 1): 57– 59.Google Scholar
Weatherburn G, Dowie R, Mistry H, Young T. Specialist pediatric cardiology advice by telemedicine. Proceedings of the Second IASTED Conference TELEHEALTH. July 3-5, 2006, Banff, AB, Canada. Available at: http://www.actapress.com/SearchResults.aspx#Papers.
Whitten PS, Mackert MS. Addressing telehealth's foremost barrier: Provider as initial gatekeeper. Int J Technol Assess Health Care. 2005: 21: 517– 521.Google Scholar
Williams T, May C, Mair F, Mort M, Gask L. 2003 Normative models of health technology assessment and the social production of evidence about telehealth care. Health Policy. 64: 39– 54.Google Scholar