National randomized controlled trial of virtual house calls for Parkinson disease

doi:10.1212/WNL.0000000000004357

Randomized Controlled Trial

. 2017 Sep 12;89(11):1152-1161.

doi: 10.1212/WNL.0000000000004357. Epub 2017 Aug 16.

National randomized controlled trial of virtual house calls for Parkinson disease

Christopher A Beck¹, Denise B Beran¹, Kevin M Biglan¹, Cynthia M Boyd¹, E Ray Dorsey², Peter N Schmidt¹, Richard Simone¹, Allison W Willis¹, Nicholas B Galifianakis¹, Maya Katz¹, Caroline M Tanner¹, Kristen Dodenhoff¹, Jason Aldred¹, Julie Carter¹, Andrew Fraser¹, Joohi Jimenez-Shahed¹, Christine Hunter¹, Meredith Spindler¹, Suzanne Reichwein¹, Zoltan Mari¹, Becky Dunlop¹, John C Morgan¹, Dedi McLane¹, Patrick Hickey¹, Lisa Gauger¹, Irene Hegeman Richard¹, Nicte I Mejia¹, Grace Bwala¹, Martha Nance¹, Ludy C Shih¹, Carlos Singer¹, Silvia Vargas-Parra¹, Cindy Zadikoff¹, Natalia Okon¹, Andrew Feigin¹, Jean Ayan¹, Christina Vaughan¹, Rajesh Pahwa¹, Rohit Dhall¹, Anhar Hassan¹, Steven DeMello¹, Sara S Riggare¹, Paul Wicks¹, Meredith A Achey¹, Molly J Elson¹, Steven Goldenthal¹, H Tait Keenan¹, Ryan Korn¹, Heidi Schwarz¹, Saloni Sharma¹, E Anna Stevenson¹, William Zhu¹; Connect.Parkinson Investigators

Affiliations

¹ From the Department of Biostatistics and Computational Biology (C.A.B.), University of Rochester, NY; National Parkinson Foundation (D.B.B., P.N.S.), Miami, FL; Department of Neurology (K.M.B., E.R.D., I.H.R., H.S.) and The Center for Human Experimental Therapeutics (E.R.D., M.A.A., M.J.E., S.G., H.T.K., R.K., S.S., E.A.S., W.Z.), University of Rochester Medical Center, NY; Division of Geriatric Medicine and Gerontology, Department of Medicine (C.M.B., Z.M., B.D.), Johns Hopkins University School of Medicine, Baltimore, MD; Simone Consulting (R.S.), Sunnyvale, CA; Departments of Neurology and Biostatistics and Epidemiology (A.W.W., M.S., S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; University of California San Francisco (N.B.G., M.K., C.M.T., K.D.); Northwest Neurological, PLLC (J. Aldred), Spokane, WA; Oregon Health and Science University (J.C., A. Fraser), Portland; Baylor College of Medicine (J.J.-S., C.H.), Houston, TX; Augusta University (J.C.M., D.M.), GA; Duke Medical Center (P.H., L.G.), Durham, NC; Massachusetts General Hospital (N.I.M., G.B.), Boston; Struthers Parkinson's Center (M.N.), Minneapolis, MN; Beth Israel Deaconess Medical Center (L.C.S.), Boston, MA; University of Miami (C.S., S.V.-P.), FL; Northwestern University (C.Z., N.O.), Evanston, IL; The Feinstein Institute for Medical Research (A. Feigin, J. Ayan), Northwell Health, Manhasset, NY; Medical University of South Carolina (C.V.), Charleston; University of Kansas Medical Center (R.P.), Kansas City; Parkinson's Institute (R.D.), Sunnyvale, CA; Mayo Clinic (A.H.), Rochester, MN; Center for Information Technology Research in the Interest of Society (CITRIS) (S.D.), University of California, Berkeley; Health Informatics Centre (S.S.R.), Karolinska Institute, Stockholm, Sweden; and PatientsLikeMe (P.W.), Derby, UK.
² From the Department of Biostatistics and Computational Biology (C.A.B.), University of Rochester, NY; National Parkinson Foundation (D.B.B., P.N.S.), Miami, FL; Department of Neurology (K.M.B., E.R.D., I.H.R., H.S.) and The Center for Human Experimental Therapeutics (E.R.D., M.A.A., M.J.E., S.G., H.T.K., R.K., S.S., E.A.S., W.Z.), University of Rochester Medical Center, NY; Division of Geriatric Medicine and Gerontology, Department of Medicine (C.M.B., Z.M., B.D.), Johns Hopkins University School of Medicine, Baltimore, MD; Simone Consulting (R.S.), Sunnyvale, CA; Departments of Neurology and Biostatistics and Epidemiology (A.W.W., M.S., S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; University of California San Francisco (N.B.G., M.K., C.M.T., K.D.); Northwest Neurological, PLLC (J. Aldred), Spokane, WA; Oregon Health and Science University (J.C., A. Fraser), Portland; Baylor College of Medicine (J.J.-S., C.H.), Houston, TX; Augusta University (J.C.M., D.M.), GA; Duke Medical Center (P.H., L.G.), Durham, NC; Massachusetts General Hospital (N.I.M., G.B.), Boston; Struthers Parkinson's Center (M.N.), Minneapolis, MN; Beth Israel Deaconess Medical Center (L.C.S.), Boston, MA; University of Miami (C.S., S.V.-P.), FL; Northwestern University (C.Z., N.O.), Evanston, IL; The Feinstein Institute for Medical Research (A. Feigin, J. Ayan), Northwell Health, Manhasset, NY; Medical University of South Carolina (C.V.), Charleston; University of Kansas Medical Center (R.P.), Kansas City; Parkinson's Institute (R.D.), Sunnyvale, CA; Mayo Clinic (A.H.), Rochester, MN; Center for Information Technology Research in the Interest of Society (CITRIS) (S.D.), University of California, Berkeley; Health Informatics Centre (S.S.R.), Karolinska Institute, Stockholm, Sweden; and PatientsLikeMe (P.W.), Derby, UK. ray.dorsey@chet.rochester.edu.

PMID: 28814455
PMCID: PMC5595275
DOI: 10.1212/WNL.0000000000004357

Randomized Controlled Trial

National randomized controlled trial of virtual house calls for Parkinson disease

Christopher A Beck et al. Neurology. 2017.

. 2017 Sep 12;89(11):1152-1161.

doi: 10.1212/WNL.0000000000004357. Epub 2017 Aug 16.

Authors

Affiliations

¹ From the Department of Biostatistics and Computational Biology (C.A.B.), University of Rochester, NY; National Parkinson Foundation (D.B.B., P.N.S.), Miami, FL; Department of Neurology (K.M.B., E.R.D., I.H.R., H.S.) and The Center for Human Experimental Therapeutics (E.R.D., M.A.A., M.J.E., S.G., H.T.K., R.K., S.S., E.A.S., W.Z.), University of Rochester Medical Center, NY; Division of Geriatric Medicine and Gerontology, Department of Medicine (C.M.B., Z.M., B.D.), Johns Hopkins University School of Medicine, Baltimore, MD; Simone Consulting (R.S.), Sunnyvale, CA; Departments of Neurology and Biostatistics and Epidemiology (A.W.W., M.S., S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; University of California San Francisco (N.B.G., M.K., C.M.T., K.D.); Northwest Neurological, PLLC (J. Aldred), Spokane, WA; Oregon Health and Science University (J.C., A. Fraser), Portland; Baylor College of Medicine (J.J.-S., C.H.), Houston, TX; Augusta University (J.C.M., D.M.), GA; Duke Medical Center (P.H., L.G.), Durham, NC; Massachusetts General Hospital (N.I.M., G.B.), Boston; Struthers Parkinson's Center (M.N.), Minneapolis, MN; Beth Israel Deaconess Medical Center (L.C.S.), Boston, MA; University of Miami (C.S., S.V.-P.), FL; Northwestern University (C.Z., N.O.), Evanston, IL; The Feinstein Institute for Medical Research (A. Feigin, J. Ayan), Northwell Health, Manhasset, NY; Medical University of South Carolina (C.V.), Charleston; University of Kansas Medical Center (R.P.), Kansas City; Parkinson's Institute (R.D.), Sunnyvale, CA; Mayo Clinic (A.H.), Rochester, MN; Center for Information Technology Research in the Interest of Society (CITRIS) (S.D.), University of California, Berkeley; Health Informatics Centre (S.S.R.), Karolinska Institute, Stockholm, Sweden; and PatientsLikeMe (P.W.), Derby, UK.
² From the Department of Biostatistics and Computational Biology (C.A.B.), University of Rochester, NY; National Parkinson Foundation (D.B.B., P.N.S.), Miami, FL; Department of Neurology (K.M.B., E.R.D., I.H.R., H.S.) and The Center for Human Experimental Therapeutics (E.R.D., M.A.A., M.J.E., S.G., H.T.K., R.K., S.S., E.A.S., W.Z.), University of Rochester Medical Center, NY; Division of Geriatric Medicine and Gerontology, Department of Medicine (C.M.B., Z.M., B.D.), Johns Hopkins University School of Medicine, Baltimore, MD; Simone Consulting (R.S.), Sunnyvale, CA; Departments of Neurology and Biostatistics and Epidemiology (A.W.W., M.S., S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; University of California San Francisco (N.B.G., M.K., C.M.T., K.D.); Northwest Neurological, PLLC (J. Aldred), Spokane, WA; Oregon Health and Science University (J.C., A. Fraser), Portland; Baylor College of Medicine (J.J.-S., C.H.), Houston, TX; Augusta University (J.C.M., D.M.), GA; Duke Medical Center (P.H., L.G.), Durham, NC; Massachusetts General Hospital (N.I.M., G.B.), Boston; Struthers Parkinson's Center (M.N.), Minneapolis, MN; Beth Israel Deaconess Medical Center (L.C.S.), Boston, MA; University of Miami (C.S., S.V.-P.), FL; Northwestern University (C.Z., N.O.), Evanston, IL; The Feinstein Institute for Medical Research (A. Feigin, J. Ayan), Northwell Health, Manhasset, NY; Medical University of South Carolina (C.V.), Charleston; University of Kansas Medical Center (R.P.), Kansas City; Parkinson's Institute (R.D.), Sunnyvale, CA; Mayo Clinic (A.H.), Rochester, MN; Center for Information Technology Research in the Interest of Society (CITRIS) (S.D.), University of California, Berkeley; Health Informatics Centre (S.S.R.), Karolinska Institute, Stockholm, Sweden; and PatientsLikeMe (P.W.), Derby, UK. ray.dorsey@chet.rochester.edu.

PMID: 28814455
PMCID: PMC5595275
DOI: 10.1212/WNL.0000000000004357

Abstract

Objective: To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable.

Methods: In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire-39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings.

Results: A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] -2.0 to 2.7 points; p = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70-120; p < 0.0001) and 38 miles per visit (95% CI 36-56; p < 0.0001).

Conclusions: Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience.

Clinicaltrialsgov identifier: NCT02038959.

Classification of evidence: This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.

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Figures

**Figure 1. Flowchart of study participants**
HIPAA = Health Insurance Portability and Accountability Act.

**Figure 2. Patient and physician satisfaction with virtual house calls**
(A) Patient satisfaction with virtual house calls (n = 320). (B) Physician satisfaction with virtual house calls (n = 361).

**Figure 3. Participants’ relative preference of virtual house calls with remote specialist vs in-person visit with usual Parkinson disease provider across different dimensions (n = 68)**

See this image and copyright information in PMC

Comment in

The virtual house call: A 21st-century innovation in the care of patients with Parkinson disease.
Shprecher DR, Majersik JJ. Shprecher DR, et al. Neurology. 2017 Sep 12;89(11):1103-1104. doi: 10.1212/WNL.0000000000004366. Epub 2017 Aug 16. Neurology. 2017. PMID: 28814459 No abstract available.

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References

1. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016;375:154–161. - PubMed
1. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. - PubMed
1. Daschle T, Dorsey ER. The return of the house call. Ann Intern Med 2015;162:587–588. - PubMed
1. Uscher-Pines L, Mehrotra A. Analysis of teladoc use seems to indicate expanded access to care for patients without prior connection to a provider. Health Aff 2014;33:258–264. - PubMed
1. Wechsler LR. Advantages and limitations of teleneurology. JAMA Neurol 2015;72:349–354. - PubMed

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[1] Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016;375:154–161. - PubMed

[2] Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016;375:154–161. - PubMed

[3] Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. - PubMed

[4] Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. - PubMed

[5] Daschle T, Dorsey ER. The return of the house call. Ann Intern Med 2015;162:587–588. - PubMed

[6] Daschle T, Dorsey ER. The return of the house call. Ann Intern Med 2015;162:587–588. - PubMed

[7] Uscher-Pines L, Mehrotra A. Analysis of teladoc use seems to indicate expanded access to care for patients without prior connection to a provider. Health Aff 2014;33:258–264. - PubMed

[8] Uscher-Pines L, Mehrotra A. Analysis of teladoc use seems to indicate expanded access to care for patients without prior connection to a provider. Health Aff 2014;33:258–264. - PubMed

[9] Wechsler LR. Advantages and limitations of teleneurology. JAMA Neurol 2015;72:349–354. - PubMed

[10] Wechsler LR. Advantages and limitations of teleneurology. JAMA Neurol 2015;72:349–354. - PubMed

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National randomized controlled trial of virtual house calls for Parkinson disease

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National randomized controlled trial of virtual house calls for Parkinson disease

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