We will evaluate facilitators and barriers to implementation of the Health-e-Access telemedicine network (HeA), a health IT application with established feasibility, efficacy, effectiveness, and efficiency in management of acute childhood illness. This focus was chosen for developmental stages of this innovative approach to care because the unpredictable occurrence and high incidence of acute childhood illness promotes acceptance of an unfamiliar model of care that is distinguished by its convenience. Three service models have evolved in use of HeA to enable telemedicine access, (1) child care, (2) school, and (3) after-hours neighborhood models. Each model is highly flexible in meeting patient needs, in part because HeA technology is web-based and includes mobile patient access units The three models presently serve families in Rochester, NY, a mid-sized city with marked racial and ethnic disparities in socioeconomic and health status. Models are in various stages of development and deployment. Each has distinct strengths and weaknesses in serving incentives of the primary stakeholders. Incentives vary among the stakeholders, including parent/patient, clinician, patient's telemedicine access site, clinician, provider organization, payers, and the community at large. Children rarely go without care in this community, although care is usually not convenient and often neither timely nor efficient. The fundamental goal of this initiative is replacement of inconvenient, inefficient and expensive traditional models of care, such as the emergency department (ED), with more convenient, high quality, less expensive models enabled by HeA.
Specific aims are to: (A) achieve substantial deployment and solidify sustainable business models for each of the three urban telemedicine service models;(B) identify facilitators and barriers;(C) monitor impact on utilization patterns;and (D) create and disseminate an implementation and sustainability toolkit. A program logic model guides the development and deployment process, the evaluation and analysis in identifying facilitators and barriers, and the development of the implementation/sustainability toolkit. Program logic links the program work plan (activities and outputs in the context of available resources and liabilities) with results (short- and intermediate-term outcomes and long-term impacts). Qualitative and quantitative methods will be used to guide program development, identify facilitators and barriers, and assess results. Utilization of all health services for children in the targeted inner-city zip code areas will be monitored with telephone and telemedicine service logs, ED encounter files, and insurance claims data. This application responds to AHRQ PAR-08-270 for support of health information technology (IT) demonstration projects that evaluate factors associated with successful implementation and utilization of health IT in order to improve the quality, safety, effectiveness and efficiency of health care in ambulatory settings. A particular focus is the AHRQ area of interest of Health IT to support patient-centered care, and the use of electronic exchange of health information to improve quality of care.

Public Health Relevance

To be replicated and sustained, proposed new models for delivering healthcare, such as the Health-e-Access Telemedicine Model, must be as good or better than existing models in meeting the needs of the people and organizations who use and operate the system. These populations include patients, care providers, and payers. This project will identify facilitators and barriers to replication of an existing telemedicine model, with proven efficiency and effectiveness, for the purpose of promoting widespread replication in other communities and for a broader range of patients.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Quality and Effectiveness Research (HQER)
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Bernstein, Steve
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University of Rochester
Schools of Dentistry
United States
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