: Acute illness in pre-school and school-age children remains a major morbidity and economic burden across the socioeconomic spectrum. Using commercially-available technology that enables clinicians to evaluate and treat ill children at a distant childcare or school site, Health-e-Access (HeA) is a novel, yet logical and efficient, approach to this serious, nation-wide problem. HeA has operated in 8 inner-city childcare centers. Evidence supports high acceptance and satisfaction by parents and child programs. Reduction in child absence due to illness has been dramatic. Keys to optimization, sustainability and expansion of HeA are integration into primary care practice, physician acceptance, and insurance reimbursement. Physician acceptance and optimization can be anticipated if reimbursement is appropriate and telehealth can be integrated efficiently in the primary care medical home to maximize continuity of care. Insurance reimbursement can be anticipated if telehealth services can be shown to reduce healthcare costs. These key issues will be addressed in the (1) northeast Rochester, and (2) southeast suburbs telehealth demonstration projects. Using the HeA telehealth model, children in 9 schools and 13 childcare programs in designated geographic areas can be evaluated by their own primary care clinicians in 9 practices. Study A will focus on impact of telehealth in child programs (childcare, schools) on utilization and cost at the level of child program (Study A1) and individual child (Study A2) utilizing a before-after design with historical and concurrent controls. Direct and indirect costs will be assessed. Study B will assess integration in primary care, for example by measuring impact on continuity of care, adherence to well-child visit schedules and immunization rates.
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