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- Title
Triangulation Analysis of Tele-Palliative Care Implementation in a Rural Community Area in Japan.
- Authors
Noriaki Aoki; Sachiko Ohta; Hiroshi Yamamoto; Nobutaka Kikuchi; Kim Dunn
- Abstract
We conducted a comprehensive evaluation of tele-palliative care by triangulation method.This consisted of qualitative analyses of 2 patients and then performing quantitative analysisof a simulated model for tele-palliative care based on that experience. Semistructuredinterviews with 2 patients were conducted for qualitative analysis. The recorded conversationswere analyzed using traditional categorization and coding techniques, looking forpatterns and themes both within and across the interviews. A state-transition process wasmodeled using a Markov model to compare the costs for three different options for patientsrequiring palliative care: admission to the palliative care unit, home care only (8physician visits), and tele-palliative care. The cost data were mainly derived from the reimbursementscale of the Japanese Health Insurance System. Sensitivity analysis was usedto assess the influence of particular conditions or costs. The qualitative assessment identifiedsome positive concepts, such as "expectation," "convenience," "reliance," and "communication."In the cost analysis, the reference case yielded the annual costs as follows:(1) costs for admission to the palliative care unit were $1,137,000; (2) costs for home carewere $521,000; and (3) costs for telepalliative care were $478,000. One-way sensitivity analysesshowed that home care was the most cost-saving strategy if the care was continued formore than 4 months or the number of physician visits during tele-palliative care could bereduced to less than 6 physician visits per month. The important issues in reducing thecost of tele-palliative care were (1) having adequate patient numbers, (2) reducing the numberof physicians' visits, and (3) offsetting the costs of telemedicine against cost savingsto the system to sustain the program. In addition, the qualitative analysis demonstratedpatients positive views of tele-palliative care.
- Subjects
JAPAN; PALLIATIVE treatment; QUALITATIVE research; RURAL geography
- Publication
Telemedicine & e-Health, 2006, Vol 12, Issue 6, p655
- ISSN
1530-5627
- Publication type
Article
- DOI
10.1089/tmj.2006.12.655