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

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

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.  

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