Browsing by Author "Ward, Marcia M"
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- ItemEffect of tele-emergency services on recruitment and retention of US rural physicians.(2014-08-13) Potter, Andrew J; Mueller, Keith J; Mackinney, A Clinton; Ward, Marcia MAs competition for physicians intensifies in the USA rural areas are at a disadvantage due to challenges unique to rural medical practice Telemedicine improves access to care not otherwise available in rural settings Previous studies have found that telemedicine also has positive effects on the work environment suggesting that telemedicine may improve rural physician recruitment and retention although few have specifically examined this
- ItemEvaluation of home telehealth following hospitalization for heart failure: a randomized trial.(2008-10-28) Wakefield, Bonnie J; Ward, Marcia M; Holman, John E; Ray, Annette; Scherubel, Melody; Burns, Trudy L; Kienzle, Michael G; Rosenthal, Gary EPrevious studies have found that home based intervention programs reduce readmission rates for patients with heart failure Only one previous trial has compared telephone and videophone to traditional care to deliver a home based heart failure intervention program The objective of this study was to evaluate the efficacy of a telehealth facilitated postdischarge support program in reducing resource use in patients with heart failure Patients at a Midwestern Department of Veterans Affairs Medical Center were randomized to telephone videophone or usual care for follow up care after hospitalization for heart failure exacerbation Outcome measures included readmission rates time to first readmission urgent care clinic visits survival and quality of life The intervention resulted in a significantly longer time to readmission but had no effect on readmission rates or mortality There were no differences in hospital days or urgent care clinic use All subjects reported higher disease specific quality of life scores at 1 year There was evidence of the value of telephone follow up but there was no evidence to support the benefit of videophone care over telephone care Rigorous evaluation is needed to determine which patients may benefit most from specific telehealth applications and which technologies are most cost effective
- ItemExtent of telehealth use in rural and urban hospitals.(2014-11-14) Ward, Marcia M; Ullrich, Fred; Mueller, Keith; ,Key Findings Data from 4 727 hospitals in the 2013 HIMSS Analytics database yielded these findings 1 Two thirds 66 0 of rural defined as nonmetropolitan and 68 0 of urban had no telehealth services or were only in the process of implementing a telehealth application One third 34 0 rural and 32 0 urban had at least one telehealth application currently in use 2 Among hospitals with live and operational telehealth services 61 4 indicated only a single department program with an operational telehealth service and 38 6 indicated two or more departments programs with operational telehealth services Rural hospitals were significantly less likely to have multiple services 35 2 than were urban hospitals 42 1 3 Hospitals that were more likely to have implemented at least one telehealth service were academic medical centers not for profit institutions hospitals belonging to integrated delivery systems and larger institutions in terms of FTEs but not licensed beds Rural and urban hospitals did not differ significantly in overall telehealth implementation rates 4 Urban and rural hospitals did differ in the department where telehealth was implemented Urban hospitals were more likely than rural hospitals to have operational telehealth implementations in cardiology stroke heart attack programs 7 4 vs 6 2 neurology 4 4 vs 2 1 and obstetrics gynecology NICU pediatrics 3 8 vs 2 5 In contrast rural hospitals were more likely than urban hospital to have operational telehealth implementations in radiology departments 17 7 vs 13 9 and in emergency trauma care 8 8 vs 6 3
- ItemImplementation of a telepharmacy service to provide round-the-clock medication order review by pharmacists.(2010-11-24) Wakefield, Douglas S; Ward, Marcia M; Loes, Jean L; O'Brien, John; Sperry, LeevonPurpose The implementation of a telepharmacy service to provide round the clock medication order review by pharmacists is described Summary Seven critical access hospitals CAHs worked collaboratively as part of a network of hospitals implementing the same electronic health record EHR computerized prescriber order entry CPOE system and pharmacy information system to serve as the health information technology HIT backbone supporting round the clock medication order review by pharmacists Collaboration permitted standardization of workflow policies and procedures Through the HIT backbone both onsite and remote pharmacists were given access to the medication orders the pharmacy information system and other patient specific clinical data in patients EHRs Orders are typically reviewed within 60 minutes of when they are entered into the system The reviewing pharmacists have remote access to the EHRs in each CAH After completing the clinical review the pharmacist selects the appropriate medication to dispense from the CAH s formulary If the medication order is not made using the CPOE system the order is scanned into a document and sent via e mail to remote pharmacists The pharmacist enters the necessary information into the EHR and pharmacy information system The medication order review process from this point forward is identical to that used for medications ordered via CPOE The new medication order is then entered into the EHR and the CAH nurse can proceed with the order Conclusion The implementation of a telepharmacy model in a multihospital health system increased access to pharmacy services allowing for round the clock medication order review by pharmacists
- ItemTelemedicine Is Associated with Faster Diagnostic Imaging in Stroke Patients: A Cohort Study.(0000-00-00) Mohr, Nicholas M; Young, Tracy; Harland, Karisa K; Skow, Brian; Wittrock, Amy; Bell, Amanda; Ward, Marcia MBACKGROUND Meeting time goals for patients with time sensitive conditions can be challenging in rural emergency departments EDs and adopting policies is critical ED based telemedicine has been proposed to improve quality and timeliness of care in rural EDs INTRODUCTION The objective of this study was to test the hypothesis that diagnostic testing in telemedicine supplemented ED care for patients with myocardial infarction MI and stroke would be faster than nontelemedicine care in rural EDs MATERIALS AND METHODS This observational cohort study included all ED patients with MI or stroke in 19 rural critical access hospitals served by a single real time contract based telemedicine provider in the upper Midwest 2007 2015 The primary outcome for the MI cohort was time to electrocardiogram EKG and for the stroke cohort was time to head computed tomography CT interpretation To measure the relationship between telemedicine and timeliness parameters generalized estimating equations models were used clustering on presenting hospital RESULTS Of participating ED visits 756 were included in the MI cohort 29 used telemedicine and 140 were included in the stroke cohort 30 used telemedicine Time to EKG did not differ when telemedicine was used 1 faster 95 confidence interval CI 4 to 7 or after telemedicine was implemented 4 faster 95 CI 3 to 10 Head CT interpretation was faster for telemedicine cases 15 faster 95 CI 4 26 No differences were observed in time to reperfusion therapy CONCLUSIONS Telemedicine implementation was associated with more timely head CT interpretation for rural patients with stroke but no difference in early MI care Future work will focus on the specific manner in which telemedicine changes ED care processes and ongoing professional education
- ItemUse Of Telemedicine For ED Physician Coverage In Critical Access Hospitals Increased After CMS Policy Clarification.(0000-00-00) Ward, Marcia M; Merchant, Kimberly A S; Carter, Knute D; Zhu, Xi; Ullrich, Fred; Wittrock, Amy; Bell, AmandaThere is a chronic shortage of physicians to cover emergency departments EDs in critical access hospitals A 2013 memorandum from the Centers for Medicare and Medicaid Services clarified that a telemedicine physician could fulfill the regulatory requirements for physician backup when advanced practice providers were at telemedicine equipped critical access hospital EDs but local physicians were not In a sample of nineteen hospitals coverage schedules in 2016 showed that seven had begun the use of tele ED physician backup for advanced practice providers decreasing local physician coverage in their EDs These seven hospitals tended to have decreasing ED staffing costs while the hospitals not applying this policy showed continually increasing staffing costs over time Telemedicine also provided other benefits such as improved physician recruitment and retention In the future more critical access hospitals will likely use telemedicine to provide physician backup for advanced practice providers staffing the ED