N. R. Laferriere1, M. Saruwatari3, X. Doan3, K. Ishihara1, D. Puapong2, S. Johnson2, R. Woo2 1Tripler Army Medical Center, Department Of Surgery,General Surgery,Honolulu, HI, USA 2Kapi’olani Medical Center for Women and Children,Pediatric Surgery,Honolulu, HI, USA 3University Of Hawaii,John A. Burns School Of Medicine,Honolulu, HI, USA
Introduction: The unique geography of the state of Hawaii presents an unusual challenge regarding access to health care. While the state’s population is spread across six islands, nearly all pediatric surgical care is delivered on O‘ahu, with the majority delivered at the one dedicated children’s hospital. This disproportionately affects the native Hawaiian and Pacific Islander populations as they represent a higher percentage of the population on the neighbor islands, compounding the access to care issues for these traditionally underserved groups. Outpatient clinic visits require patients and a parent/legal guardian to travel to O’ahu for what could be only a 15-minute visit. The direct and opportunity costs of this can be significant. The aim of this study was to identify the number of telehealth candidates to estimate the statewide opportunity for telehealth services for outpatient pediatric surgical care.
Methods: This was a retrospective chart review examining all pediatric patients who were transported from other Hawaiian Islands for consultation with a pediatric surgeon on O‘ahu over a 4 year period from Sept 1, 2013- Aug 31, 2017. All patients who traveled from an outer island to O’ahu and were seen in the pediatric surgery clinic at the state’s primary children’s hospital were included in the study. Each patient visit was examined to determine if the visit could have been conducted via telehealth. Encounters were deemed suitable for telehealth if they did not meet any of the following exclusion criteria: need for admission, need for surgery or invasive procedures within 24 hours, need for additional subspecialty consultations, and need for emergency room evaluation after their visit with the surgeon. Administrative cost data was then used to determine the direct, insurance-based costs of the travel for the encounter. Patient demographics were also analyzed to determine the home island of the patient and their ethnic background.
Results: 1,081 patients were seen in the pediatric surgery clinic at the state’s primary children’s hospital from the outer islands over a 4 year period. Of these patients, 31% (335 patients) met criteria as candidates for telehealth visits with 45% coming from Hawai’i, 28% from Maui, 16% from Kaua’i, 8.4% from Moloka’i, and 1.5% from Lana’i. Most patients were identified as Native Hawaiian or Asian (46% and 29%, respectively). The average cost per trip was $112.53, leading to a potential cost savings of $37,697 over 4 years.
Conclusion: Over 30% of outpatient pediatric surgical encounters met stringent criteria as candidates for telehealth delivery of care. 46% of these patients identified as native Hawaiian. This represents a significant opportunity for direct, travel-based cost savings as well as opportunity cost savings associated with the implementation of telehealth delivery of outpatient pediatric surgical care in Hawai‘i.