Telehealth: School-Based Program Outcomes and...
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Telehealth: School-Based Program Outcomes and Expansion Evelyn Terrell, OTD, MHSA, OTR/L Regional Director, Rehab Services and Telehealth Operations
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Transcript of Telehealth: School-Based Program Outcomes and...
Telehealth: School-Based Program Outcomes and Expansion
Evelyn Terrell, OTD, MHSA, OTR/L
Regional Director, Rehab Services and Telehealth Operations
About Nicklaus Children’s Hospital
A not-for-profit freestanding pediatric teaching hospital
Over 220 pediatric sub-specialists in 40+ pediatric subspecialties
79% of physicians are board-certified
Ranked nationally in 8 pediatric specialties in US News and World
Report
61 physicians on medical staff were listed in the Best Doctors in
America List for 2015-2016
Magnet™ recognized by the American Nurses Credentialing Center
Gold-level Beacon Awards for Excellence from the American
Association of Critical-Care Nurses in three specialized ICUs
Renowned for excellence in all aspects of pediatric medical care
from birth through adolescence
Employed and private practice providers across a multitude of
disciplines and specialties work together to provide, comprehensive,
multidisciplinary care the patients
o Licensed beds…………………..…….289
o Inpatient admissions………….......10,544
o Total surgeries…………….……….16,223
o Emergency department visits…....86,893
o Hospital outpatient visits………...218,945
o Off Campus Visits………….…....290,914
o Employees………………………....4,000+
o Medical staff ………………………….931
About Nicklaus Children’s Hospital
New Advanced Pediatric Care Pavilion
The 212,000 square-foot pavilion will house:
The neonatal, cardiac and pediatric
intensive care units
The hematology/oncology inpatient units
An expanded bone marrow transplant unit
A 10-bed obstetrical unit for babies
requiring immediate intervention after birth
Family-centered amenities
Network of Outpatient Centers
Telehealth Center
Re-imagining the healthcare experience and innovating how we support families and children at the point of illness and throughout the continuum of care
Expanding telehealth into the retail market, partnering with insurance providers and offering wellness services for adults and children
Support sophisticated video-conferencing, diagnostics and testing, allowing clinicians, parents and patients to consult with a team of specialists
Our Telehealth Center brings expert care and peace of mind to families and children –wherever they are, whenever they need us
Programs:
Primary Care/Convenient Care –Employer Groups
Primary Care/ Convenient Care and Basic Nursing – Schools
Subspecialist Services
NICU Nursing – BabyCare and Lactation Services
Dental Mobile Unit
Rehabilitation Services
Nutrition Services
Mental/ Behavioral Health
Social Services
Child Life
Support Groups
Care/ Case Management
Primary Care – School Health
Settings:
Schools
Technology:
Mobile Solution (suitcase)
Commonly seen minor illnesses in children:
Cold, flu, fever, sore throat, earache
Sinus or upper respiratory infection
Rash or skin conditions
Eye conditions
Allergies
Laryngitis
Head Lice
Insect Bites
Mouth and Cold sores
Financial Model:
Partnership with the Miami-Dade County Public Schools, The Children’s Trust,
private donor
Healthcare Team:
Family ARNPs and physicians
On site Telehealth Presenter
School Telehealth
Volumes
35
10
72
80
0
10
20
30
40
50
60
70
80
90
K-8 Airbase for InternationalEducation
Richmond Heights Middle School* Southwest High School W.R. Thomas Middle School
Number of patients seen per location
* Only participated during 2015-2016 pilot
School Telehealth - Chief Complaints
18
22
57
2
14
26
57
12
0
10
20
30
40
50
60
Cough Fever Eye Irritation Congested Derm Ear Pain Sore Throat Other
Chief Complaints
Totals year to date
School Telehealth
Medications Ordered
76
65
40
14
0
10
20
30
40
50
60
70
80
Prescription Over theCounter(OTC)
Prescription & OTC No Medication
Total number of medications ordered
School Telehealth
Assumptions on Missed School Days
1%
32%
67%
Child likely to havegone home due toparent preference
Parent/Child likely tomiss school or workfor 2+ days
Likely to have gonehome if not forTelehealth Services
School Attendance Rates
84
86
88
90
92
94
96
98
100
2015 Q1 2015 Q2 2016 Q3 2016 Q4 2016 Q1 2016 Q2 2017 Q3 2017 Q4
Quarterly Attendance for 2015/2016 – 2016/2017 School Years
Airbase Elementary Richmond Heights Middle W.R. Thomas Middle Southwest Miami Sr High
School Telehealth
Parent and Student Satisfaction Survey Results
113
81
0
20
40
60
80
100
120
Your Overall treatment experience with telehealth
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied
Evidence – Clinical Effectiveness,
Satisfaction & Cost
Student health and educational performance are interdependent.
A school-based telehealth clinic can bring resources and collaboration to schools located in rural, poor, and medicallyunderserved areas (Burke et al., 2008).
Telehealth is “increasing access to acute and specialty care for children; helping children and families managechronic conditions; facilitating health education for children, families and school personnel; and increasing thecapacity of school nurses and school-based health centers to meet the healthcare needs of students” (The Children’s
Partnership, 2009).
A study showed a 63% reduction in absence resulting from illness in urban children (McConnochie, Wood, Herendeen &Roghmann, 2005).
“Health-e-Access was well accepted by a substantial, diverse group of patients….Convenience and convenience-related experience dominated perceptions” (McConnochie et al., 2010).
Families evaluated an acute-care pediatric telemedicine service in urban neighborhoods and indicated 97.6% satisfaction (satisfied or highly satisfied rating) (McIntosh et al., 2014)
“The Health-e-Access telemedicine model holds potential to reduce health care costs, mostly through replacement of ED visits for non-emergency problems” (McConnochie et al., 2009).
References
Burke, J. B., Ott, R., Albright, M., Bynum, A., & Hall-Barrow, J. (2008). Rural school-based telehealth: How to make it happen. Clinical
Pediatrics, 47(9), 926-929.
McConnochie K.M., Wood N.E., Herendeen N.E., ten Hoopen, C.B., & Roghmann, K.J. (2010). Telemedicine in urban and suburban childcare
and elementary schools lighten family burdens. Telemedicine and e-Health, 16(5), 533-542.
McConnochie, K.M., Wood, N.E., Herendeen, N.E., Ng, P.K., Noyes, K., Wang, H., & Roghmann, K.J. (2009). Acute illness care patterns
change with use of telemedicine. Pediatrics, 123(6), e989-e995.
McConnochie K.M., Wood N.E., Herendeen N.E., & Roghmann, K.J. (2005). Telemedicine reduces absence resulting from illness in urban
child care: evaluation of an innovation. Pediatrics, 115(5), 1273-82.
McIntosh, S., Cirillo, D., Wood, N., Dozier, A.M., Alarie, C. & McConnochie, K.M. (2014). Patient evaluation of an acute care pediatric
telemedicine service in urban neighborhoods. Telemedicine Journal and E-health, 20(12), 1121-1126.
National Association of School Nurses (2012). The Use of Telehealth in Schools. Retrieved from
https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/52/Telehealth-in-
Schools-The-Use-of-Revised-2012
Spaulding, R.J., Davis, K. & Patterson, J. (2008). A comparison of telehealth and face-to-face presentation for school professionals supporting
students with chronic illness. Journal of Telemedicine and Telecare, 14, 211-214.
The Children’s Partnership (2009). School-Based telehealth: An innovative approach to meet the healthcare needs of California's children
(Issue Brief No. 6). Retrieved from
http://www.childrenspartnership.org/AM/Template.cfm?Section=Reports1&Template=/CM/ContentDisplay.cfm&ContentID=13701
Questions?
Cindy Harrah ARNP, MSN
Clinical Director, School Health Program
786-624-3290
Jill Tahmooressi, RN-BC, BSN, NC SN
Nursing Director, Ambulatory Services
Urgent Care Services
Clinical Director, DOH School Telehealth Program
954-385-6268
School Health and Telehealth Program
Contacts:
Evelyn Terrell, OTD, MHSA, OTR/L
Regional Director of Rehabilitative Services and
Telehealth Operations
786-624-4589
