Rural Telehealth Research Center: Rural Health Research Products & Journal Articles

2021

Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment
Journal Article
Date: 11/2021
This study explores facilitators and barriers to implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. Researchers conducted semi-structured interviews with 50 key personnel involved in the School-Based Telehealth Network Grant Program.
Using CPT Charges as an Economic Proxy for Telehealth and Non-Telehealth Emergency Department Utilization
Policy Brief
Date: 11/2021
This brief examines economic data on emergency department visits from unrelated rural hospitals. By using the reported Current Procedural Terminology code and associated charge, we explore the characteristics of the resulting dataset in terms of distribution and association with related variables.
HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-Site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks
Journal Article
Date: 01/2021
The Health Resources and Services Administration funded six grantees to provide telehealth services in rural emergency departments (tele-ED) and gather data for the telehealth evidence base. This paper examines trends across multiple tele-ED networks and heterogeneity in processes and outcomes.

2020

Telehealth Use in a Rural State: A Mixed Methods Study Using Maine's All-Payer Claims Database
Journal Article
Date: 10/2020
This study examines trends in telehealth use in Maine and identifies barriers and facilitators to its adoption. While telehealth appears to improve access to behavioral health and speech therapy services, provider shortages, lack of broadband, and restrictive Medicare and commercial coverage plans limit telehealth services use in rural areas.
Telebehavioral Health Use Among Rural Medicaid Beneficiaries: Relationships With Telehealth Policies
Journal Article
Date: 09/2020
This study assesses policy levers potentially supporting sustained use of telehealth services. Among rural Medicaid fee-for-service beneficiaries with behavioral health needs, engaging patients through informed consent within provider settings that receive facility fees may facilitate improved access to telebehavioral health services.
Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six Networks
Journal Article
Date: 08/2020
In a cohort of 4,324 tele-ED cases across 26 months in 65 hospitals in 6 tele-ED networks, 20% were averted transfers, and 43% of those were then routinely discharged rather than being transferred. Averted transfers saved on average $2,673 in avoidable transport costs per patient, with 63.6% of these cost savings accruing to public insurance.
Process of Identifying Measures and Data Elements for the HRSA School-Based Telehealth Network Grant Program
Policy Brief
Date: 06/2020
This brief details work to identify measures and develop data elements appropriate to school-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration's School-Based Telehealth Network Grant Program.
Measure and Data Element Identification for the HRSA Evidence-Based Tele-Behavioral Health Network Program and the HRSA Substance Abuse Treatment Telehealth Network Grant Program
Policy Brief
Date: 04/2020
This brief details work to identify measures and develop data elements appropriate to tele-behavioral health, create an Excel-based tool, and collect data from grantees in the Health Resources and Services Administration's Evidence-Based Tele-Behavioral Health Network Grant Program and Substance Abuse Treatment Telehealth Network Grant Program.
Identifying Measures and Data Elements for the HRSA Evidence-Based Tele-Emergency Network Grant Program
Policy Brief
Date: 03/2020
This brief details multi-project work to identify measures and develop data elements appropriate to emergency department-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration Evidence-Based Tele-Emergency Network Grant Program.
Emergency Department Telemedicine Consults Are Associated With Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients
Journal Article
Date: 02/2020
Acute myocardial infarction (AMI) is a common, deadly emergency requiring rapid diagnosis and treatment. In this rural cohort, emergency department-based telemedicine was associated with improved timeliness of electrocardiogram and fibrinolysis. This study adds to evidence that telemedicine can improve timeliness of AMI care in rural hospitals.
Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments
Journal Article
Date: 01/2020
Sepsis is a life-threatening emergency, and timely "bundled" care improves survival. In this rural cohort, telemedicine in the emergency department (tele-ED) improved sepsis bundle adherence, including timely fluid resuscitation and antibiotic administration. Tele-ED may be a scalable intervention to improve sepsis emergency care in rural EDs.

2019

Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort
Journal Article
Date: 11/2019
This was a study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication. The effect of tele-ED varied by network, suggesting network characteristics may influence the realized tele-ED benefit for stroke care.
Tele-Emergency Behavioral Health in Rural and Underserved Areas
Journal Article
Date: 11/2019
This paper describes how two distinct tele-emergency department (ED) behavioral health models address challenges in access and placement for patients in rural and underserved areas presenting to EDs. The notable difference in disposition rates between cases and controls shows the impact each model is having on care practices and processes.
Pediatric Tele-Emergency Care: A Study of Two Delivery Models
Journal Article
Date: 04/2019
This study describes two tele-emergency programs that provide care to pediatric populations. Qualitative descriptions of the two tele-emergency department (ED) models and key characteristics of the patient populations served by tele-ED are presented. The study informs others about evaluative measures and how tele-ED works in practice.

2018

Patterns of Telehealth Use Among Rural Medicaid Beneficiaries
Journal Article
Date: 10/2018
This study uses data from the 2011 Medicaid Analytic eXtract (MAX) to examine the prevalence of telehealth use among rural and urban Medicaid beneficiaries, characteristics of telehealth users, types of telehealth services provided, and diagnoses associated with telehealth use.
Implementation Strategies for Telestroke: A Qualitative Study of Telestroke Networks in North Carolina
Journal Article
Date: 09/2018
Through semi-structured interviews with 24 telestroke representatives, this study examines the adoption decision process and strategies employed during telestroke network development, implementation, and sustainability. We found differences across networks in terms of network structure, quality monitoring, and performance feedback.
Telestroke Adoption Among Community Hospitals in North Carolina: A Cross-Sectional Study
Journal Article
Date: 05/2018
This study identifies community and hospital characteristics associated with the adoption of telestroke among acute care hospitals in North Carolina.
Serum Anion Gap Predicts Lactate Poorly, but May Be Used to Identify Sepsis Patients at Risk for Death: A Cohort Study
Journal Article
Date: 04/2018
Our study of 4,159 emergency department patients determined anion gap and serum bicarbonate poorly predict changes in lactate and mortality. In resource-limited settings where lactate is unavailable, anion gap ≥ 20 mEq/L may be used to further risk-stratify patients for ongoing sepsis care, but lactate remains a preferred biomarker.

2017

Improving Access to High Quality Sepsis Care in a South Dakota Emergency Telemedicine Network
Policy Brief
Date: 08/2017
This brief describes an implementation initiative designed to increase use of emergency department-based telemedicine consultation for patients with severe sepsis or septic shock. This initiative is the first step of an analysis to estimate the effect of telemedicine on sepsis care and outcomes.
Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients
Journal Article
Date: 07/2017
This article examines the use of telemedicine to help improve care for trauma patients and to try to close the gap between rural and urban outcomes for these patients. The study involved patients treated in critical access hospitals and emergency departments.
Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study
Journal Article
Date: 02/2017
Traumatic injury is a leading cause of death in the U.S. Rural residents have limited access to trauma care, and telemedicine has been proposed to improve trauma care locally. This study describes patient-level factors associated with telemedicine and measures the association between telemedicine consultation and interhospital transfer.

2016

Telemedicine Penetration and Consultation Among Rural Trauma Patients in Critical Access Hospital Emergency Departments in North Dakota
Policy Brief
Date: 09/2016
This study describes the penetration of ED-based telemedicine in North Dakota critical access hospitals and its use for rural trauma patients. Investigators showed that telemedicine subscription increased to 81 percent of rural North Dakota hospitals, and 11 percent of patients in a telemedicine-capable ED used telemedicine as part of their care.