Innovative Telemedicine Programs Improve Continuity of Care

Published on in Neonatology Update

The Division of Neonatology’s Neonatal Telemedicine Program continues to support the application of telemedicine technology to post-discharge patient follow-up, family engagement, and education through the following initiatives.

Transitioning from the NICU to home

In 2015, under the leadership of Dr. John Chuo, Associate Professor of Clinical Pediatrics and Neonatal Quality Officer, we began a program to help caregivers of complex infants care for their babies during the immediate post-discharge period through tele-visits. The program includes a dedicated team of physicians, nurse practitioners, and staff (Drs. Janet Lioy, Marisa Brant, and Nicole Pouppirt, and April Willard, Elizabeth Brown, Majorie Masten, and Kevin Moran).

Since its inception, the program has seen more than 130 families and done an average of 1 to 4 tele-visits per week, receiving very positive feedback from parents and their baby’s general pediatricians.

About 30% of parents report that the tele-visits prevented either an extra call to their pediatrician or a visit to either an urgent or emergency care facility. The tele-visits have provided parents a reassuring sense of care continuity after discharge from the NICU, emphasizing the CHOP mission to deliver the best care possible to patients and families.

Using the tele-visits, the NICU care team has been able to provide psychological reassurance and encouragement to parents at home, reinforce the education parents receive before discharge, monitor and correct misunderstandings of care plans, detect and resolve problems before they worsen, and much more.

In the process, the NICU team has been vigilant to ensure tele-visits are done in the context of the medical home model (as recommended by the American Academy of Pediatrics), thereby keeping the patient’s primary care practices informed and involved at all times.

This partnership with primary care clinicians is critically important to ensuring the best care for our patients. Many of the tele-visits are done at the baby’s first pediatrician appointment where the NICU team provides the pediatrician a brief 2-minute synopsis of the patient’s conditions that may be important to monitor and answers questions the pediatrician may have.

This program has gained attention through its publication in Advances in Neonatal Care and presentation at national conferences (ATA, AAP, VON, CHNC). Planning is underway for a multicenter study through a pediatric telehealth research collaborative.

Keeping parents and babies connected from afar

CHOP’s Newborn/Infant Intensive Care Unit (N/IICU) is piloting a project that allows parents to see their baby in the N/IICU from home. The goal of this project is to help parents who have difficulty visiting their babies stay connected with their baby.

Facilitating multidisciplinary collaboration

In collaboration with CHOP’s Division of Radiology (Drs. Janet Reid and Brian Hopely), the NICU leads (Drs. John Chuo and Anne Ades) conduct teleradiology rounds to review complex cases once a week. The goal is to improve personal communication between radiologists and neonatologists.

Supporting research on outcomes and telehealth

Dr. Chuo is co-founder and current chair of Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT), a research collaborative dedicated to pediatrics that began in 2015 and has grown to more than 180 members from 104 institutions from 31 states and 2 countries. Ours is the largest program in the country participating in this collaborative (see map).

SPROUT’s objectives are to:

  • Identify best or potential best practices of pediatric telehealth implementation as determined by the impact of such practices on healthcare quality
  • Establish a network of institutions to conduct collaborative research on telehealth implementation
  • Apply and study the efficacy of using implementation science methods in the effort

SPROUT has 7 research interest groups (Neonatology, Critical Care, Transport, Surgery, School-based Telehealth, Pediatric Subspecialties, and Complex Care) and recently completed its first descriptive study on pediatric telehealth programs and their infrastructure (Olson CA, McSwain SD, Curfman AL, Chuo J. The current pediatric telehealth landscape. Published online ahead of print, Feb. 27, 2018. Pediatrics.).

Most recently, the American Academy of Pediatrics has endorsed the SPROUT research collaborative to serve as the research arm of its Section on Telehealth Care.