Telemedicine consultations do not differ from telephone consultations in quality of care for seriously ill childrenTelemedicine offers same quality of care as telephone calls

BACKGROUND AND OBJECTIVES: This study is a secondary analysis of a pragmatic, cluster-randomized crossover trial in which telemedicine consultations were associated with reduced interfacility transfers but not with differences in medication prescribing errors. Telemedicine may also influence physician-related quality of care compared with telephone consultations; however, few randomized studies have examined this outcome in pediatric acute care settings. METHODS: We conducted a pragmatic, cluster-randomized crossover trial to determine the impact of pediatric critical care telemedicine consultations compared with telephone consultations on quality of care provided to seriously ill children younger than 15 years presenting to 16 rural and community emergency departments (EDs) over 2 years. Quality of care was measured using a 5-domain, validated implicit review instrument involving medical record review by experts in pediatric emergency medicine. Our primary analytic approach used multilevel linear regression models with random intercepts to account for clustering. RESULTS: We enrolled 696 children. In the intention-to-treat analysis, 537 (77.1%) were assigned to telemedicine and 159 (22.9%) were assigned to telephone consultations. The mean total quality-of-care scores for telephone and telemedicine were 25.3 (SD = 3.5) and 25.2 (SD = 3.5), respectively. In adjusted models, consultation modality was not significantly associated with total quality-of-care score (coefficient = -0.21; 95% CI, -0.83 to 0.41; P = .51). Domain-specific scores also did not differ by consultation modality. CONCLUSIONS: In the context of previously reported reductions in interfacility transfers, telemedicine consultations in rural and community EDs were not associated with differences in physician-related quality of care compared with telephone consultations.