Objective: To characterize institutional practices, eligibility criteria, monitoring strategies, and perceived barriers related to remote patient monitoring (RPM) for neonates discharged home on nasogastric tube (NGT) feeds across Children’s Hospital Neonatal Consortium (CHNC) institutions. Methods: We conducted a cross-sectional, web-based survey of neonatal care providers across CHNC institutions. The survey assessed eligibility criteria for home NGT feeding, RPM implementation protocols, feeding regimens, follow-up practices, monitoring duration, outcomes tracked, and perceived barriers. Responses were collected anonymously via Research Electronic Data Capture and analyzed using descriptive statistics. Results: A total of 25 centers responded (50% response rate), with most respondents from neonatology (96%). Overall, 84% of centers reported discharging selected neonates home on NGT feeds, and 75% of centers without an established home NGT program planned implementation within 1–2 years. Medical stability (90.5%) and reliable caregiver involvement (85.7%) were commonly required, although eligibility criteria varied. Monitoring platforms, frequency, and duration were heterogeneous, with 61.9% continuing monitoring until NGT discontinuation. Fewer than half (47.6%) reported billing for home NGT monitoring services. Commonly tracked outcomes included growth (61.9%), gastrostomy tube placement (52.4%), and readmissions (47.6%). Major barriers included limited staffing support (66.7%), staff time commitment (57.1%), and reimbursement concerns (42.9%). Conclusions: Home NGT feeding is commonly practiced among the responding CHNC institutions; however, eligibility and monitoring practices vary considerably. Consensus-based eligibility criteria, standardized monitoring and outcome measures, and sustainable staffing and reimbursement models may improve consistency and facilitate evaluation of these programs.
BACKGROUND:Evidence is limited on how patient-reported symptoms relate to telehealth use and whether telehealth visits yield comparable symptom outcomes to in-person care in routine oncology practice. METHODS:An observational cohort of adult patients who received cancer treatment 6 months to 3 years prior to a scheduled oncology visit across two academic medical centers and their affiliated community sites in North Carolina and Michigan was recruited. Pre- and postvisit telephone surveys were linked to electronic health records and geocoded data. Surveys assessed being offered a telehealth visit option and six symptoms (fatigue, pain, insomnia, anxiety, sadness, and discouragement). Chi-square tests were used to compare patient-reported symptoms by visit modality, and logistic regression was used to examine symptom associations with being offered and accepting telehealth visits. Propensity score-weighted changes in symptom composite scores pre- to postvisit were compared by visit modality. RESULTS:Among 610 patients (496 in-person and 114 telehealth visits), symptoms were common (fatigue 79.7%, pain 73.9%, insomnia 65.9%, anxiety 62.5%, sadness 64.4%, and discouragement 35.1%). A telehealth visit option was offered to 24.8% of patients, among whom 66.2% accepted it. Patients reporting sadness were less likely to be offered a telehealth visit than those without sadness (22.1% vs. 29.5%; p = 0.04) and, if offered, were less likely to accept a telehealth visit (59.8% vs. 75.0%; p = 0.03). In contrast, patients reporting pain were more likely to be offered telehealth than those without pain (26.6% vs. 19.5%; p = 0.04). Changes in composite symptom scores from pre- to postvisit were small and not statistically significant for either in-person (95% confidence interval [CI]: -0.05, 0.01) or telehealth visits (95% CI: -0.12, 0.05). CONCLUSION:Although access to telehealth oncology visits varies by symptom presentation, routinely offered and accepted telehealth visits appear to lead to near-term symptom outcomes similar to in-person visits.
BACKGROUND:The social determinants of health (SDoH) of uninsured patients are an underlying mechanism of avoidable emergency department (ED) use, but only 28.4% of EDs across the United States routinely screen for SDoH. Municipality-funded telehealth programs have emerged as a potential strategy to expand access to primary care and reduce preventable ED visits. However, no existing review has mapped the evidence on publicly supported telehealth models targeting uninsured urban residents. The purpose of this scoping review was to examine the cost-benefits of municipality-funded telehealth services on ED utilization among vulnerable populations in the U.S. METHODS:Articles were retrieved from PubMed, Medline, and Google Scholar using concept blocks and search terms and were managed using Covidence®. This resulted in 477 articles reviewed against the inclusion and exclusion criteria. Seven articles met eligibility requirements and were included for data extraction and analysis. RESULTS:The seven included articles indicated that telehealth utilization prompts primary care access, increased appointment adherence, and less ED use. In addition, telehealth services proved to be economic and cost-beneficial and bridged the gap in health inequality by addressing SDoHs, mostly among uninsured and vulnerable populations. CONCLUSIONS:Leveraging telehealth in uninsured populations produces positive effects on primary care access and utilization and subsequent reduction in avoidable ED use. All telehealth interventions reviewed were funded by donations, hospital systems, or nongovernment organizations. To support telehealth to combat avoidable ED use, there remains untapped opportunity for municipality-funded telehealth initiatives. This multisource focus on telehealth access can provide broader and sustained access for uninsured urban residents.
INTRODUCTION:This study examined factors influencing physical therapy patients' preference for virtual over in-person physical therapy. Key variables included physical therapy patients' technology comfort (TC), virtual treatment self-efficacy (VTSE), perceived provider expertise (PPE), and perceived provider integrity (PPI). METHODS:A cross-sectional survey of physical therapy patients was conducted in collaboration with a regional physical therapy provider. Data were collected from February to May 2025, resulting in 141 complete responses from patients aged 18-83 years. RESULTS:Patients' mean preference for virtual over in-person physical therapy was 2.97 (±1.27), as measured on a 5-point Likert scale. Multiple regression analysis indicated that patients' preference for virtual physical therapy (VPT) was positively associated with VTSE (β = 0.450, p < 0.001) and PPE (β = 0.484, p = 0.010). Additionally, TC had a significant positive interaction with PPI (β = 0.301, p = 0.035), and VTSE had a significant positive interaction with PPE (β = 0.358, p = 0.033). Demographic factors were not significantly associated with preference for VPT. CONCLUSIONS:The findings suggest that ]patients' confidence and provider-related perceptions have important associations with their preference for VPT. By fostering patients' confidence in applying virtual treatments and enhancing perceptions of provider expertise and integrity, physical therapy providers may influence patient preference for telerehabilitation. The findings highlight the need for further research on how patients' preference for virtual care is shaped by how they view their health care providers.
