Inner city families, whose children are most burdened by morbidity and whose reliance on childcare is most important to their ability to improve economic circumstances, are those least equipped to deal with the challenge of illness in childcare. Using commercially-available information technology that enables clinicians to evaluate and treat ill children at a distant childcare site, Health-e-Access is a novel, yet logical and efficient, approach to a serious problem of national as well as local significance. The service has operated in 7 large inner-city childcare centers (and soon, the 8th) in Rochester. Evidence already firmly supports high levels of acceptance and satisfaction with this innovation by parents and childcare programs. Demonstrated reduction in child absence due to illness has been dramatic and undoubtedly impacts parent work absence. We anticipate that employers, too, will encourage expansion of Health-e-Access. Keys to expansion and acceptance can be anticipated if appropriate reimbursement is available and telehealth services can be integrated efficiently in the primary care medical home. Insurance reimbursement can be anticipated if telehealth services can be shown to reduce healthcare costs. Both issues will be addressed. Study #1 (office integration) will assess the feasibility and acceptability of integrating telehealth in 2 primary care practices serving inner city children, and it will assess impact on continuity of care. Study #2 (utilization and cost impact) will assess the hypothesis that health care use and costs associated with acute medical problems for children in childcare has been reduced, and it will quantify reduction. Cost impact will be assessed in before-and-after and concurrent comparisons. Costs incurred by childcare populations before telehealth (period 1) will be compared with costs incurred after telehealth startup (period 2). Control for secular trends will be achieved through comparisons to centers that did not have telehealth in either period 2 or period 2. Study #3 (parent and employer benefits) will estimate the economic benefits of Health-e-Access for parents and for employers, providing value estimates for events assessed in Study 2.
Listed is descending order by year published.
McConnochie K, Wood N, Herendeen N, ten Hoopen CB, Denk L, Neuderfer J. Integrating telemedicine in urban pediatric primary care: provider perspectives and performance. Telemed J E Health 2010 Apr;16(3):280-8.
McConnochie KM, Wood N, Herendeen N, ten Hoopen CB, Roghmann KJ. Telemedicine in urban and suburban childcare and elementary schools lightens family burdens. Telemed J E Health. 2010 Jun;16(5):533-42.
McConnochie KM, Wood NE, Herendeen NE, Ng PK, Noyes K, Wang H, Roghmann KJ. Acute illness care patterns change with use of telemedicine. Pediatrics. 2009 Jun;123(6):e989-95.
Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM. Dental screening of preschool children using teledentistry: a feasibility study. Pediatr Dent. 2007 May-Jun;29(3):209-13.
McConnochie KM, Tan J, Wood NE, Herendeen NE, Kitzman HJ, Roy J, et al. Acute illness utilization patterns before and after telemedicine in childcare for inner-city children: a cohort study. Telemed J E Health. 2007 Aug;13(4):381-90.
McConnochie KM, Conners GP, Brayer AF, Goepp J, Herendeen NE, Wood NE, et al. Differences in diagnosis and treatment using telemedicine versus in-person evaluation of acute illness. Ambul Pediatr. 2006 Jul-Aug;6(4):187-95; discussion 196-7.
McConnochie KM, Conners GP, Brayer AF, Goepp J, Herendeen NE, Wood NE, et al. Effectiveness of telemedicine in replacing in-person evaluation for acute childhood illness in office settings. Telemed J E Health. 2006 Jun;12(3):308-16.
McConnochie KM, Wood NE, Kitzman HJ, Herendeen NE, Roy J, Roghmann KJ. Telemedicine reduces absences due to illness in urban child care: evaluation of an innovation. Pediatrics. 2005 May;115(5):1273-82.
Cost Effectiveness, Telehealth, Primary Care, Child Care