Parent Experience and Cost Savings Associated With a Novel Tele-physiatry Program for Children Living in Rural and Underserved Communities

Arch Phys Med Rehabil. 2022 Jan;103(1):8-13. doi: 10.1016/j.apmr.2021.07.807. Epub 2021 Aug 21.


Objective: The aim of this study was to investigate parent and therapist experience and cost savings from the payer perspective associated with a novel tele-physiatry program for children living in rural and underserved communities.

Design: We designed a noninferiority, cluster-randomized crossover study at 4 school-based clinics to evaluate parent experience and perceived quality of care between a telemedicine-based approach in which the physiatrist conducts the visit remotely with an in-person therapist and a traditional in-person physiatrist clinic.

Setting: Four school-based clinics in Northern California.

Participants: A total of 268 encounters (124 telemedicine and 144 in-person) were completed by 200 unique patients (N=200).

Interventions: Not applicable.

Main outcome measures: Parent and therapist experience scores.

Results: For parents and therapists, experience and perceived quality of care were high with no significant differences between telemedicine and in-person encounters. For parents whose children received a telemedicine encounter, 40 (54.8%) reported no preference for their child's subsequent encounter, 21 (28.8%) preferred a physiatrist telemedicine visit, and 12 (16.4%) preferred a physiatrist in-person visit. From the payer perspective, costs were $100 higher for in-person clinics owing to physician mileage reimbursement.

Conclusions: We found that school-based tele-physiatry for children with special health care needs is not inferior to in-person encounters with regard to parent and provider experience and perceived quality of care. Tele-physiatry was also associated with an average cost savings of $100 per clinic to the payer.

Keywords: Disabled children; Healthcare disparities; Physical medicine and rehabilitation; Rehabilitation; Rural populations, Telemedicine.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Attitude to Health*
  • Child
  • Child, Preschool
  • Cross-Over Studies
  • Disabled Children / rehabilitation*
  • Female
  • Humans
  • Male
  • Parents / psychology*
  • Physical and Rehabilitation Medicine
  • Rural Health Services*
  • Telemedicine / economics*
  • Telemedicine / methods*
  • Vulnerable Populations*