Abstract
Travel cost and travel distance can decrease access to care. Telemedicine services can reduce patient travel distance and cost in subspecialty consult services. The impact of telemedicine services on travel distance and travel cost in hematology consult services has not been widely studied. We analyzed the impact of a hematology telemedicine consult service in the Michael E. Debakey VA Medical center (MEDVAMC) in Houston, Texas. The MEDVAMC provides subspecialty consult services for Community-based Outpatient Clinics (CBOC). Our hypothesis in this study was that the establishment of a hematology telemedicine clinic would reduce travel distance for the patient and travel pay made by the MEDVAMC for this specialty with high level of satisfaction among veterans.
We conducted a prospective cohort study of veterans enrolled in the hematology telemedicine clinic at the MEDVAMC from September, 2011 to June, 2013. Any veteran referred to or established in the hematology clinic was eligible to be enrolled in the telemedicine service if they lived closer to a CBOC than to the MEDVAMC. The telemedicine encounter included meeting with a hematologist, a social worker and/or nutritionist. Patients went to their assigned community clinic to connect with the hematology telemedicine service. Data on demographics and diagnosis (benign or malignant hematology condition) were collected. Outcome variables included travel distance, estimated travel cost and patient satisfaction scores with the telemedicine service. Cost of travel was defined as the estimated amount that the MEDVAMC reimburses eligible patients for their travel costs.
The hematology telemedicine clinic enrolled 255 veterans during the study period. Among these patients, 195 (76%) had benign hematology conditions and 60 (24%) had malignant hematology conditions. 237 (93%) of patients were male, and 156 (61%) lived in a rural area. The mean travel distance saved was 64 miles (SD 11.5). This translated into an estimated average of 21 dollars of travel pay saved per patient. Out of all telemedicine encounters, there was a 42% survey return rate. In 94% of these surveys veterans reported they were satisfied with the visit and that they would recommend the hematology telemedicine program.
The establishment of a telemedicine consult service in a referral center decreased travel distance for patients and travel pay cost. Most patients that answered the feedback surveys reported they were satisfied and that they would recommend the program. Other studies looking at cost-effectiveness, and patient and disease-related outcomes will help understand further the impact and benefits of such a program.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
