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Results/Evaluation
Network
growth
In
1995 the UPTN became operational with 7 video conferencing sites
and a 6-port multipoint control unit (bridge). At present the UTPN
represent 42 sites, 77 systems, 48 ports on the bridge, and more
than 6,000 annual connections. The bridge technology integrates
the few remaining original ISDN systems with the more recent IP technology.
The
graph below represents real time, video conferencing activity for
the UPTN from 1995 to present. Home health and store and forward
activity data are maintained separately.
Note:
From 1995 through 1998 individual events were recorded. 1999 through
present the number of connections are reported. The statistics are
conservative as not all sties report all activities as independence
is fostered.
Contact:
dwurth@mgh.org

Patient
Encounters
The
graph below represents patient encounters that represent traditional
physician/patient consultations along with other patient services.
Some of the other patient services include; Tumor Boards, Family
bondings (Neonatal Intensive Care and Acute care), and support groups.
It does not include home health or store and forward technology.
Contact:
lskrenes@mgh.org

Clinical
Encounters
The
graph below represents patient-practitioner consultations. We currently
have 21 speciality offices and 60 specialists who have provided
telemedicine services to residents in the Upper Peninsula..
Contact:
smakela@mgh.org

Telehome
Care
This section under revision, please check back soon.
Patient Satisfaction
Surveys
Patient
satisfaction data was collected through phone surveys of telehealth
patients from 2001 through 2003. Michigan State University evaluation
staff under the direction of Pamela Whitten, PhD, conducted the
interviews. Patients were asked to respond on a scale of 1-5 to
a series of Likert style questions with 5 begin strongly agree and
1 begin strongly disagree. In addition, comments were solicited
in an open-ended format.
Note:
Survey tools are protected by copyright. To request full text or
replication of the tools contact Pamela Whitten, PhD, at pwhitten@msu.edu
Conventional Telehealth
During the evaluation
period (2001-2003), 310 patients were interviewed via telephone by Michigan
State University researchers. The purpose of the patient surveys
was to gauge the perceptions of using telemedicine services as a
supplement to traditional health care services. Participants responded
to 14 closed ended questions and ten open-ended questions.
Mean scores
from the Likert-type questions are presented in Table 1. The patients
rated their level of agreement with the statements from either 1,
strongly disagree, to 5, strongly agree.
Descriptive
statistics demonstrate exceptionally high satisfaction with telehealth.
Participants rated all aspects of telehealth, from ease of use
to comfort and communication, between 4.54 and 4.75 out of a 5.0
scale. Participants were neutral about telehealth only being used
when a professional cannot be physically present ( =
3.08). And, patients disagreed with the statement that telehealth
limited their privacy ( =1.82).
Table
1: Patient Perceptions of Clinical Telehealth
Questions
|
Mean
(n=310)
|
Standard
Deviation |
I
found the telehealth equipment easy to use. |
4.75
|
.60
|
I
think telehealth is a good way to provide medical care. |
4.53
|
.79
|
It
was easy to communicate with the other person during the telehealth
consult. |
4.58
|
.83
|
I
enjoy telehealth visits. |
4.38
|
.98
|
I
felt comfortable using the telehealth equipment. |
4.54
|
.89
|
I
was able to communicate what was bothering me. |
4.5
|
.81
|
The
health care provider was able to address what was bothering
me. |
4.56
|
.82
|
The
care that I received via the telehealth consult was as good
as a regular in-person visit. |
4.39
|
1.10
|
I
would rather be seen in-person than over the telehealth equipment.
|
3.08
|
1.31
|
I
believe that the telehealth equipment increases my access
to health care. |
4.41
|
1.09
|
I
felt telehealth limited my privacy. |
1.82
|
1.34
|
Telehealth
should only be used when a health care professional cannot
be physically present. |
3.08
|
1.44
|
More
people should have access to telehealth programs. |
4.77
|
.56
|
Overall,
I am satisfied with the telehealth service that I received.
|
4.72
|
.68
|
The
perceptions by patients were more clearly explained during the open-ended
segments of the interviews. Forty-seven percent of the respondents
explained that a traditional health care visit does differ from
a telehealth visit and 42% claimed that there is no difference.
Those who felt there is a difference between the delivery modalities
explained this was due to lack of personal touch (43%); the fact
that technology is being used (24%) and the fact that it eliminated
the need for travel (11%).
Patients explained
that the decision to provide telecare comes primarily from the physician
(48%), an MGHS representative (32%) or a local telehealth staff
member (9%). Ten percent of the patients reported that they had
asked for telehealth services themselves.
Patients were
quick to espouse the advantages of telehealth. Responses and sample
comments included:
- Saving Travel
for Patient or Provider (58%)
"For
people who aren't mobile, it is a blessing to not have to travel."
"I think
it saves a lot of mileage especially when you can solve the problems
right here in your own town."
"My doctor
said that riding long distances might hurt the healing process of
my incision. So, it was just an obvious choice to not drive that
long distance to Marquette."
"I'm told
that stress contributed to my heart attack. And, let me tell you,
driving to Marquette is stressful. So, you tell me, is that an
advantage or what?"
"This way
the doctor doesn't have to come here and he can stay in Marquette
to help his other patients that have had surgery."
- Saving Time
and Increased Convenience (25%)
"It
is so much quicker and convenient. It is really hard to beat an
hour versus about 12."
"This just
works so well for us. We're busy, just like every other family,
and this takes a day long production into an hour at most."
- Eliminates
Burdens for Caretakers (5%)
"I
am legally blind and my wife doesn't drive, so I would normally
have to ask my daughter. This way, it's not such a big deal.
She probably wouldn't even have to take off work ."
"It is hard
to find a ride to Marquette. So, you have to schedule with the
doctor a time that you can find a ride. That's hard. You might
have to wait a long time. With this it's easier because I can
take a bus and not have to worry about bothering anyone. I can do
it myself."
Almost 90%
of the respondents stated that they would use telehealth services
again.
Telehome
Care
During
the three-year evaluation period, 49 telehome care patients were
interviewed regarding their usage of telehome care services. These
patients were diagnosed as CVA, COPD, or CHF. The interviews were
administered two weeks after the initiation of service date in order
to ensure the patients had had significant time to form a perception
of the service. The surveys consist of eleven open-ended questions
and eight close-ended questions. Mean
scores for the Likert-type questions are presented in the Table
2. Patients rated their agreement with the statements from 1,
strongly disagree, to 5, strongly agree. As
with patient perceptions with traditional clinical telehealth, patients
receiving telehome health services were extremely positive in their
perceptions. Mean scores for all items concerning ease of use,
comfort, and quality of services ranged from 4.52-4.95. Patients
disagreed in their responses to preferring to be seen in person
rather via telehealth ( =2.25)
and were neutral in their response regarding telehealth only being
appropriate for use when a health care professional could not be
present (
=3.21)
Table
2: Perceptions of Telehome Health
Questions
|
Mean
(n=49)
|
Standard
Deviation |
I
found the telehealth equipment easy to use. |
4.84
|
.78
|
I
think telehealth is a good way to provide home health care
for patients with heart/lung disease. |
4.95
|
.82
|
I
think telehealth is a good way to provide educational information
on COPD/CHF management. |
4.52
|
.80
|
It
was easy to communicate with the other person during the telehome
health consult. |
4.67
|
.66
|
The
care that I received via the telehome health equipment was
as good as a regular in-person visit. |
3.76
|
1.21
|
I
would rather be seen in-person than over the telehome health
equipment. |
2.25
|
1.25
|
Tele-home
health should only be used when a health care professional
cannot be physically present. |
3.21
|
1.39
|
Overall,
I am satisfied with the telehome health service that I received.
|
4.68
|
.78
|
Patients listed
a wide range of advantages for telehome health, including:
- Increased
access to health care (24%)
- Increased
convenience for patient L 16.5%)
- Saves travel
and/or time for the patient and/or provider (12%)
- Saves travel
and/or time for the patient and/or provider (12%)
In
regard to disadvantages associated with telehome health, 47% of
the respondents stated that there are no disadvantages to utilizing
the telehome health services.
Those
listing disadvantages mentioned:
Technology issues/quality (22%)
- Non-telehealth
related (10%)
- Lack of physical
touch (4%)
More
than half of the patients felt that telehome health had enabled
them to better manage their chronic health conditions. The majority
of respondents, 76% said that "yes" they would like receive telehome
health again.
Diabetes
Project - In a related telehome health project conducted in
the UP for diabetics, a total of 54 patients were enrolled. Two
died before the project was completed, four were discharged and
subsequently admitted to nursing homes. Of the remaining enrollees,
33 patients or their caregivers participated in one-on-one telephone
interviews during the 12 months of this project that concluded in
2002. A researcher at Michigan State University interviewed participants
after they had used the telehome health service for a period of
at least two weeks.
With
this population of patients who have diabetes, the most important
perceived advantage to receiving telehome health was the educational
component. Patients were able to review their diets and medications
with the nurses on a regular basis. They stated that the telehealth
visits encouraged them to monitor their disease more carefully.
If they were not feeling well, they could review their recent
food intake or physical activity with the nurse and learn how to
make beneficial adjustments. The telehealth visits coupled with
the skilled visits gave them more opportunity to learn. The nurses
who participated in this project spoke very highly of the diabetic
teaching materials that were included with the telehealth equipment,
as well. They believe that the booklet and the telehome health
unit facilitated self-sufficiency. Another perceived advantage was
related to increased social interaction. Some of the participants
were homebound and their social interactions were limited to communicating
with others in the home or talking on the phone. The video feature
of the telehealth unit brought another friendly face into their
homes.
More
detailed results are available by contacting Susan Makela Director
of Telehealth smakela@mgh.org
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