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Abstract
Objective: This study was undertaken to determine if ALS patients evaluated via telemedicine received the same quality of care as patients evaluated by traditional face-to-face encounters.
Methods: A retrospective cohort study design was used. Participants were patients diagnosed with ALS that received multidisciplinary care at the tertiary Cleveland VA ALS Centre between 1 March 2008- and 31 anuary 2015. Participants were not randomised, but chose telemedicine based on preference, disability level or distance from the clinic. Telemedicine in this study consisted of a video conferencing platform enabling remote rather than face-to-face encounters with participants.
Results: There was no significant association between receiving quality ALS care and the mode of care. There was a trend for telemedicine patients to utilise home health care less often than those that received clinic care (AOR 0.50; 95% CI 0.16–1.59). There was no significant difference in survival time between the two groups (log-rank test χ2 = 3.62, df = 1, p = 0.05). Patients receiving telemedicine had a higher probability of remaining stable or having <30% decrease in ALSFRS-R over time (log-rank test χ2 = 4.46, df = 1, p = 0.03). There was a significantly lower risk of disease progression for patients receiving telemedicine (HR = 0.39, 95% CI = 0.16–0.93).
Conclusions: Patients managed by telemedicine received the same quality of care and had similar outcomes to those patients seen via traditional face-to-face encounters. Telemedicine is an effective platform for delivering high quality tertiary ALS care.
Acknowledgements
We appreciate the engagement of providers at remote sites who collaborate with us using telemedicine to care for veterans with ALS: Michael Orinick, (Erie VA Medical Centre), Sally Ebert (Erie VA Medical Centre), Jonathan R. Strayer, MD (Dayton VA Medical Centre), Marlene Davis-Pierce RN (Dayton VA Medical Centre), Anita Surran (Chillicothe VA Medical Centre), and Rhonda Bailey (Chillicothe VA Medical Centre). There was no compensation provided for contribution.
Declaration of interest
Frances McClellan- . Board member ALS Association, Northern Ohio Chapter. Care Services Committee Chair.
Disclaimer
The contents of this article do not necessarily represent the views of the United States Department of Veterans Affairs or the United States Government.
Funding
This study was unfunded.
IRB Statement
The use of this data for publication was determined to be exempt from IRB formal review process and the informed consent process.