1. Tamara Broadnax, MSN, RN, NEA-BC VCU Health Telemedicine Director
Adolescent Sickle Cell Disease Transition to Adult Care Using telemedicine Technology Telemedicine Technology
Tamara Broadnax, MSN, RN, NEA-BC
VCU Health Telemedicine Director
Spring 2016
Hello I am Tamara Broadnax. The Director of Telemedicine at VCU Health. The transition period of adolescents from pediatric to adult care can be very difficult. Adolescents lose their Medicaid coverage and their structured high school environment. Once these patients are on their own they are expected to manage their healthcare. Many patients with Sickle Cell Disease are not prepared for this transition. Intervention prior to the transition to independence can be helpful. The introduction to remote home monitoring and video visits at home allows the patients to have direct connections with their care team. The technology will allows a seamless transition from the pediatric hem-onc team to the adult hematology team.

2. Improve Health Lower Cost Better Care
The infusion of telehealth technology into health care and health care delivery has presented new opportunities for increasing patient access to care and decreasing costs, while improving desired care outcomes
Improve Health
Lower Cost
Better Care
Decrease Mortality
Decrease Readmission
Improve Quality of Life
Better Disease Management
Improves Patient Outcomes
New Model of Clinical, Translational and Population Health Care (Care Delivery Disruption)
Reduce Inpatient Readmissions
Decreased ED overcrowding and unnecessary visits
Reduced Labor Costs (cheaper/ more cost efficient than home visits)
Drives Continuous Relationship and follow up with the Care Teams
Increases Cooperation among Clinicians creating an environment of shared responsibility
Improve Patient Participation and Satisfaction
Increases Patient Access
Telemedicine is an effective delivery method of clinical care.* Telemedicine enables the triple aim of improving Health , lowering costs and providing better care*
Due to the debilitating nature of this chronic condition and the vulnerability of these patients, Telemedicine technologies offer the ability to provide care to these patients whenever they need it without requiring them to travel to the Medical Center. Telemedicine allows greater patient engagement, adherence to treatment, self-management and improvement of the health outcomes for these patients.

3. <<<PICOT Question>>>
Adolescent Sickle Cell Disease Transition to Adult Care Using Telemedicine Technology
Problem Statement
Sickle Cell Disease is a costly chronic condition where patients can become acutely ill and require high utilization of hospital services. Advances in treatment have extended the life expectancy and quality of life for these patients, however many patients have difficulty transitioning from pediatric to adult care. Young adults between the ages of 18–30 have higher hospitalizations, readmissions, acute care utilization, and mortality during this time period. (Porter, 2014)
<<<PICOT Question>>>
In adolescent Sickle Cell Patients, how does the use of Telemedicine technology as compared to patients who do not utilize the technology, affect the transition to Adult Care six months after High School Graduation?
Sickle Cell Disease is a costly chronic condition where patients can become acutely ill and require high utilization of hospital services. Advances in treatment have extended the life expectancy and quality of life for these patients, however many patients have difficulty transitioning from pediatric to adult care. Young adults between the ages of 18–30 have higher hospitalizations, readmissions, acute care utilization, and mortality during this time period.
Combining this problem and the advantages of Telemedicine led to this PICOT Question—
In adolescent Sickle Cell Patients, how does the use of Telemedicine technology as compared to patients who do not utilize the technology, affect the transition to Adult Care six months after High School Graduation?
Porter, Jerlym S., Graff, J. Carolyn, Lopez, Alana D., & Hankins, Jane S. (2014). Transition From Pediatric to Adult Care in Sickle Cell Disease: Perspectives on the Family Role. Journal of Pediatric Nursing, 29(2),

4. Evidence-Based Recommendations and Associated Outcomes
Measurements
Outcomes
11th
Pain
Nutrition
Hydration
School Attendance
Emotional State
Attendance in Adult Clinic
Hospital Utilization
Medication Adherence
Patient and Provider Satisfaction
12th
12+
For this project we will issue HIPAA Compliant software that can be stored on the personal devices of 3 different groups of High School Pediatric Sickle Cell Students at the beginning of the school year.**
The groups will be composed of those currently enrolled in 11th grade/A group who will start their senior year/And a group who have just graduated in June and monitor their usage for 6 months.*
We will measure Pain, Nutrition, hydration, school attendance and emotional state. * Our outcomes will measure Attendance in adult clinic, hospital utilization, medication adherence, and patient and provider satisfaction.
The benefit of the project is that it provides access to care without requiring the patient to travel. With Early intervention it is possible to avert negative outcomes such as an Emergency department visit, sickling crisis, and an inpatient stay. The benefit to the institution is that it reduces the costs to care for these chronically ill patients because there is better medication and wellness adherence by the patient and timely response by staff. Use of the emergency department and length of stay are reduced because the patient’s conditions are managed outside of the hospital before they become problematic.*
Success defined by Reduced Health Care Utilization, Improved Quality of Life, Follow-up with adult team after initial clinic visit.
Success defined by Reduced Health Care Utilization, Improved Quality of Life, and Follow-up with adult team after initial clinic visit.

5. Estimated direct and indirect costs are as follows:
Pediatric Sickle Cell Transition Program
Grant Period: N/A
Budget Period: 1 July Jun 2018
Project Year: FY 2017 YEAR ONE
Personnel Title Base Salary % of Effort Project Salary Fringe % Fringe Amount Total
RN Coordinator , % , % ,788
Fringe Benefit (30%)
TOTAL PERSONNEL EXPENSES: 1,788
*RN salary based on 1 hour (three 20 min visits) of follow-up appointments each week.
Intervention Materials:
Webcamera 1 desktop $
TOTAL OTHER DIRECT COSTS: 65
Purchased Services:
Consultants:
Consultant Telemedicne Director
Contracts:
Contractor Web based Application for patients ,000 4,000
TOTAL PURCHASED SERVICES: 4,000
Direct Costs: Personnel + Other Direct Costs + Purchased Services ,853
Indirect Costs: 10% of Direct Costs
GRAND TOTAL YEAR 1: $6,438
Annualized Amount $536
Revenue Associated with Chronic Care Management--$45 per patient (12-15)/month x $6,480-$8,100
**RN Salary fixed (6,438-2,373= 4,065) therefore (6,480-4,065) will net $2,415- $4035 per year + Outcome Cost Savings
Request
Our request is based on assigning an RN to coordinate the care of these patients. Not every patient will not need daily follow-up and we estimate that the RN will spend 1 hour reviewing data and following up with 3 patients a week. **
The RN will need a webcam installed at her workstation.**
The HIPAA compliant software which can be downloaded on the patients device costs $4,000.
There is revenue associated with these visits and the Department will receive $45 per patient per month. Estimating participants yields between $6,500-$8,000 in revenue per year.
The RN’s salary is actually fixed so if you factor out the personnel cost this program will net between $2,400-$4,000 plus the costs of outcome savings from reduced hospital utilization.—Thank You