Browsing by Author "Marcin, James P"
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- ItemAppropriateness of Disposition Following Telemedicine Consultations in Rural Emergency Departments.(2015-01-21) Yang, Nikki H; Dharmar, Madan; Kuppermann, Nathan; Romano, Patrick S; Nesbitt, Thomas S; Hojman, Nayla M; Marcin, James PTo compare the appropriateness of hospital admission in eight rural emergency departments among a cohort of acutely ill and injured children who receive telemedicine consultations from pediatric critical care physicians to a cohort of similar children who receive telephone consultations from the same group of physicians
- ItemChanges in diagnosis, treatment, and clinical improvement among patients receiving telemedicine consultations.(2005-03-23) Marcin, James P; Nesbitt, Thomas S; Cole, Stacey L; Knuttel, Robin M; Hilty, Donald M; Prescott, Pamela T; Daschbach, Martha MThe aim of this study was to determine whether outpatient telemedicine specialty consultations to primary care clinicians result in changes in a patient s diagnosis treatment management and clinical outcomes Medical records of patients who received two or more clinical telemedicine consultations in dermatology psychiatry and endocrinology were evaluated in a nonconcurrent retrospective analysis Three indicators were used to measure changes in the processes of care and clinical outcomes change in diagnosis change in treatment and patient clinical improvement A retrospective review of 223 individual telemedicine patient medical records was conducted Specialty telemedicine consultations were found to result in changes in diagnoses in 48 of the cases changes in treatment therapy in 81 6 of the cases and clinical improvement in 60 1 These results are consistent with previous literature that has assessed changes in processes of care and outcomes from face to face specialty consultations in outpatient clinics Changes in diagnosis and treatment therapy were found to be associated with clinical improvement with odds ratios ORs of 2 66 95 confidence interval CI 1 47 4 83 and 11 22 95 CI 4 49 31 48 respectively This study found that telemedicine consultations resulted in changes in diagnosis and treatment regimens and also are associated with clinical improvements
- ItemClinical management and patient outcomes among children and adolescents receiving telemedicine consultations for obesity.(2008-06-26) Shaikh, Ulfat; Cole, Stacey L; Marcin, James P; Nesbitt, Thomas SRural residents report lower likelihood of exercising and higher rates of obesity heart disease and diabetes compared to their urban counterparts Our goals were to 1 investigate the outcomes of telemedicine consultations for pediatric obesity on changes additions to diagnoses diagnostic evaluation or treatment and 2 determine whether changes in diagnostic and management recommendations made by the consultant were associated with improvements in patient nutrition activity level and weight We conducted a retrospective medical record review of patients referred to a University affiliated Children s Hospital Pediatric Telemedicine Weight Management Clinic for a diagnosis of obesity Of the 139 children and adolescents who received pediatric weight management consultations during the study period 99 patients met inclusion criteria Weight management consultations resulted in changes additions to diagnoses in 77 8 of patients and changes additions to diagnostic evaluation in 79 8 of patients Of patients seen more than once 80 7 showed improvement in clinical outcomes Of patients seen more than once 80 6 improved their diet 69 4 increased activity levels 21 0 showed slowing of weight gain or weight maintenance and 22 6 showed weight reduction Improvements in clinical outcomes were not associated with changes additions to diagnoses Odds Ratio OR 0 98 95 Confidence Interval CI 0 25 3 98 and were weakly associated with changes additions to diagnostic evaluations OR 2 23 95 CI 0 58 8 73 However changes additions to treatment were associated with improvement in weight status OR 9 0 95 CI 1 34 76 21 Obesity consultations were associated with changes additions to diagnoses diagnostic evaluation and treatment Treatment changes were associated with improvement in weight status Telemedicine weight management consultations have the potential to result in modifications in patient care plans and outcomes
- ItemFinancial benefits of a pediatric intensive care unit-based telemedicine program to a rural adult intensive care unit: impact of keeping acutely ill and injured children in their local community.(2013-04-10) Marcin, James P; Nesbitt, Thomas S; Struve, Steven; Traugott, Craig; Dimand, Robert JThe objective of this research was to examine the fiscal impact of telemedicine consultations for acutely ill and injured children in a rural setting using pediatric intensive care unit ICU telemedicine One hundred seventy nine acutely ill and injured infants and children were cared for in the Mercy Redding ICU from April 2000 to April 2002 Data were gathered from these patients including 47 patients who received 70 pediatric ICU telemedicine consultations during the same time period Transport and hospital costs avoided were calculated for patients who received telemedicine consultations Group 1 and for those not transferred due to the availability telemedicine consultations Group 2 estimated to be one half of the 179 patients Group 2 The revenue generated in the rural ICU based on the ability to keep these patients was also determined An estimated annual cost savings of 172 000 and 300 000 for transport and inpatient care was demonstrated for Group 1 and Group 2 respectively Additionally this program resulted in generating 186 000 and 279 000 of inpatient revenue annually for the two groups at the rural hospital The cost of this program was approximately 120 000 per year Given the substantial financial savings support for underserved rural programs and significant funds kept in the rural community this may serve as a viable model for providing care to acutely ill and injured infants and children
- ItemGetting a Head Start: Expediting Neurosurgical Intervention in Children Transported With Intracranial Hemorrhage With Telemedicine.(0000-00-00) Zwienenberg, Marike; Marcin, James P
- ItemImpact of critical care telemedicine consultations on children in rural emergency departments.(2013-09-24) Dharmar, Madan; Romano, Patrick S; Kuppermann, Nathan; Nesbitt, Thomas S; Cole, Stacey L; Andrada, Emily R; Vance, Cheryl; Harvey, Danielle J; Marcin, James PTo compare the quality of care delivered to critically ill and injured children receiving telemedicine telephone or no consultation in rural emergency departments
- ItemThe impact of telemedicine intensivist support and a pediatric hospitalist program on a community hospital.(2013-10-01) Labarbera, Jaclin M; Ellenby, Miles S; Bouressa, Paul; Burrell, Jill; Flori, Heidi R; Marcin, James PBecause of centralization of care pediatric patients often require transfer for subspecialty care We evaluated the impact of telemedicine critical care consultation and a pediatric hospitalist program on enabling patients to remain at a community hospital
- ItemImpact of telemedicine on the quality of forensic sexual abuse examinations in rural communities.(2014-09-09) Miyamoto, Sheridan; Dharmar, Madan; Boyle, Cathy; Yang, Nikki H; MacLeod, Kristen; Rogers, Kristen; Nesbitt, Thomas; Marcin, James PTo assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms photo video documentation and medical records using two structured implicit review instruments Among the 183 patients included in the study 101 55 2 children were evaluated at telemedicine hospitals and 82 44 8 were evaluated at comparison hospitals Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam the genital exam documentation of examination findings the overall assessment and the summed total quality score pUnder0 05 for each Evaluation of the photos videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo video quality completeness of the examination and the summed total completeness and accuracy score pUnder0 05 for each Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations more complete examinations and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support
- ItemInaugural paediatric telehealth colloquium.(2007-05-23) Parsapour, Kourosh; Smith, Anthony C; Armfield, Nigel; Marcin, James P
- ItemInterstate Licensure for Telemedicine: The Time Has Come.(2014-12-10) Kwong, Mei Wa; Gutierrez, Mario; Marcin, James P
- ItemPerceptions of local health care quality in 7 rural communities with telemedicine.(2005-01-25) Nesbitt, Thomas S; Marcin, James P; Daschbach, Martha M; Cole, Stacey LRural health services are difficult to maintain because of low patient volumes limited numbers of providers and unfavorable economies of scale Rural patients may perceive poor quality in local health care directly impacting the sustainability of local health care services
- ItemTelehealth at UC Davis--a 20-year experience.(2013-04-22) Nesbitt, Thomas S; Dharmar, Madan; Katz-Bell, Jana; Hartvigsen, Gunnar; Marcin, James PTelehealth at the University of California Health System began as a telefetal monitoring connection with a rural hospital in 1992 and evolved to become the Center for Health and Technology CHT in 2000 The Center supports the vision of the University of California Davis UC Davis Health System a healthier world through bold innovation The CHT focuses on the four pillars of the academic health center clinical services research and scholarly work education and public service Since 1996 the Center has provided more than 33 000 telemedicine consultation excluding teleradiology telepathology and phone consultations in over 30 clinical specialties and at more than 90 locations across California Research and continuous evaluation have played an integral role in shaping the telehealth program as well as strategic collaborations and partnerships In an effort to expand the field of telehealth the CHT provides telehealth training for health professionals technical specialists and administrators Furthermore it also plays an integral role in workforce development through the education of the next generation of community primary care physicians through Rural Programs In Medical Education Rural PRIME and continuing educational programs for working health professionals through videoconferencing and Web based modalities The Center is supported through a variety of funding sources and its sustainability comes from a mix of fee for service payment contracts grants gifts and institutional funding Together with key partners UC Davis has educated and informed initiatives resulting in legislation and policies that advance telehealth Looking toward the future UC Davis is focused on technology enabled healthcare and supporting synergy among electronic health records health information exchange mobile health informatics and telehealth
- ItemTelemedicine consultations and medication errors in rural emergency departments.(2013-12-03) Dharmar, Madan; Kuppermann, Nathan; Romano, Patrick S; Yang, Nikki H; Nesbitt, Thomas S; Phan, Jennifer; Nguyen, Cynthia; Parsapour, Kourosh; Marcin, James PTo compare the frequency of physician related medication errors among seriously ill and injured children receiving telemedicine consultations similar children receiving telephone consultations and similar children receiving no consultations in rural emergency departments EDs
- ItemTelemedicine for the care of children in the hospital setting.(2014-02-11) McSwain, S David; Marcin, James PTelemedicine is by no means a new technology given that audio video telecommunication links have been utilized for the provision of medical services since the 1950s Nonetheless telemedicine is currently in a phase of rapid growth and evolution The combination of increasingly affordable and powerful networking computing and communication technology along with the continued nationwide crisis in health care access and costs has created a tipping point whereby telemedicine has progressed from a novel means of practicing medicine to practical tool to help address our nation s health care needs Telemedicine has also evolved beyond a means of providing care to remote communities to becoming a versatile tool in the delivery of health care in a variety of non rural settings Although no one can be everywhere at once telemedicine allows us to be in more places at once than we ve ever been before The problems of disparities and access to care are even more evident in pediatrics where subspecialists are fewer in number and more regionalized than adult providers Numerous successful telemedicine programs across the country have demonstrated the impact that these technologies can have in pediatrics with many more programs in development As a versatile means of delivering care telemedicine can be used at any point during the course of a health care encounter as not only a means of expanding our reach but also as a means of increasing efficiency Using telemedicine to provide consultations to community hospitals has been shown to improve quality of care strengthen the referral base for the consulting facilities facilitate cost savings and improve the financial bottom line for both referring and consulting facilities This review highlights some of the ways in which telemedicine is being used to facilitate timely and effective pediatric care in a variety of hospital settings
- ItemThe Use of Telemedicine to Address Disparities in Access to Specialist Care for Neonates.(0000-00-00) Sauers-Ford, Hadley S; Marcin, James P; Underwood, Mark A; Kim, Jae H; Nicolau, Yona; Uy, Cherry; Chen, Shelby T; Hoffman, Kristin RINTRODUCTION Outcomes for premature and critically ill neonates are improved with care provided by neonatologists in a neonatal intensive care unit NICU For smaller hospitals maintaining the personnel and equipment necessary for the delivery and care of unexpectedly high risk neonates is a significant challenge To address this disparity in access telemedicine has been increasingly used to support providers patients and their families in community newborn nurseries and NICUs The purpose of this review is to present the current state of the use of telemedicine by regional NICUs to support community newborn nurseries NICUs and families METHODS A literature review was conducted by two independent reviewers Articles were selected for inclusion if they described the use of telemedicine with neonates or in the NICU Two reviewers assessed the quality of the articles using the National Heart Lung and Blood Institute Study Quality Assessment Tools RESULTS Fourteen articles were identified After consensus discussion eight of the articles were rated good and six were rated fair by the two reviewers Many of the articles suggested improvements in quality of care family satisfaction and reductions in the cost of care Unfortunately a majority of the studies to date have had small sample sizes or were performed in a single institution and lacked robust evaluations of patient and family centered outcomes and provider decision making CONCLUSIONS While these early studies are promising more robust studies involving more patients and more institutions are needed to identify opportunities where telemedicine can impact health outcomes patient centeredness or costs of care of neonates
- ItemThe use of telemedicine to provide pediatric critical care consultations to pediatric trauma patients admitted to a remote trauma intensive care unit: a preliminary report.(2004-04-29) Marcin, James P; Schepps, Donald E; Page, Kimberly A; Struve, Steven N; Nagrampa, Eule; Dimand, Robert JInjured pediatric patients in remote communities are often cared for at trauma centers that may be underserved with respect to pediatric specialty services The objective of this study is to describe a pilot telemedicine project that allows a remote trauma center s adult intensive care unit to obtain nontrauma nonsurgical related pediatric critical care consultations for acutely injured children
- ItemUse of telemedicine to provide pediatric critical care inpatient consultations to underserved rural Northern California.(2004-03-05) Marcin, James P; Nesbitt, Thomas S; Kallas, Harry J; Struve, Steven N; Traugott, Craig A; Dimand, Robert JTo report a novel application of telemedicine and to assess the resulting quality and satisfaction of care Study design An existing telemedicine program was evaluated through the use of a nonconcurrent cohort design Cohorts of patients were compared by means of the Pediatric Risk of Mortality version III PRISM III to adjust for severity of illness and assess risk adjusted mortality rates Satisfaction and quality of care surveys administered to the pediatric patient s parents and providers were also analyzed
- ItemUsing telemedicine to improve communication during paediatric resuscitations.(2005-07-22) Kon, Alexander A; Marcin, James P
- ItemUsing telemedicine to provide pediatric subspecialty care to children with special health care needs in an underserved rural community.(2004-01-02) Marcin, James P; Ellis, Jeff; Mawis, Roland; Nagrampa, Eule; Nesbitt, Thomas S; Dimand, Robert JFor children with special health care needs CSHCN that live in rural medically underserved communities obtaining subspecialty care is a challenge Telemedicine is a means of improving access to these children by addressing rural physician shortages and geographic barriers This article reports a medical needs assessment of parents guardians with CSHCN and the status of a telemedicine program for CSHCN as well as the results of parent guardian and local provider satisfaction with the telemedicine program
- ItemVideoconferencing to reduce stress among hospitalized children.(2014-07-02) Yang, Nikki H; Dharmar, Madan; Hojman, Nayla M; Sadorra, Candace K; Sundberg, Diana; Wold, Gary L; Parsapour, Kourosh; Marcin, James PFamily Link is a videoconferencing program that allows hospitalized children and their parents to virtually visit family members and friends using laptops webcams and a secure Wi Fi connection We evaluated the association of Family Link use on the reduction in stress experienced by children during hospitalization