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Chilukuri N, Links AR, Prichett L, Tschudy M, Showell N, Polk S, Perrin EM, Hughes HK. Comparison of Telemedicine Usage at Two Distinct Medicaid-Focused Pediatric Clinics. Telemed J E Health 2024. [PMID: 38938205 DOI: 10.1089/tmj.2023.0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Objective: To compare telemedicine versus office visit use at two Medicaid-focused pediatric primary care clinics. Methods: Retrospective cohort study from March 15, 2020 - March 15, 2021 at two Medicaid-focused pediatric primary care clinics. Site A and Site B care for different populations (Site B care for mostly immigrant families with preferred language Spanish). Outcomes included the percent of visits conducted through telemedicine and reason for visit. Descriptive statistics, univariable and multivariable mixed multilevel logistic regression, were used to assess relationship between patient demographics and telemedicine use. Results: Out of 17,142 total visits, 13% of encounters at Site A (n = 987) and 25% of encounters at Site B (n = 2,421) were conducted using telemedicine. Around 13.8% of well-child care (n = 1,515/10,997), 36.2% of mental health care (n = 572/1,581), and 25.0% of acute care/follow-up (n = 1,893/7,562) were telemedicine visits. After adjustment for covariates, there was no difference in odds of a patient having any telemedicine use by preferred language, sex, or payor. Patients 1-4 years of age had the lowest odds of telemedicine use. At Site A, patients who identified as Non-Hispanic Black (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.24-0.45), Hispanic/Latinx (OR = 0.40, 95% CI = 0.24-0.66), or other race/ethnicity (OR = 0.35, 95% CI = 0.23-0.55) had lower odds of telemedicine use in comparison to Non-Hispanic White. Conclusions: Telemedicine was successfully accessed by Medicaid enrollees for different types of pediatric primary care. There was no difference in telemedicine use by preferred language and payor. However, differences existed by age at both sites and by race/ethnicity at one site. Future research should explore operational factors that improve telemedicine access for marginalized groups.
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Affiliation(s)
- Nymisha Chilukuri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Anne R Links
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura Prichett
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Megan Tschudy
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nakiya Showell
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Polk
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eliana M Perrin
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Helen K Hughes
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Ukert B, Lawley M, Kum HC. Geographic disparities in telemedicine mental health use by applying three way ANOVA on Medicaid claims population data. BMC Health Serv Res 2024; 24:494. [PMID: 38649985 PMCID: PMC11034036 DOI: 10.1186/s12913-024-10898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Utilization of telemedicine care for vulnerable and low income populations, especially individuals with mental health conditions, is not well understood. The goal is to describe the utilization and regional disparities of telehealth care by mental health status in Texas. Texas Medicaid claims data were analyzed from September 1, 2012, to August 31, 2018 for Medicaid patients enrolled due to a disability. METHODS We analyzed the growth in telemedicine care based on urban, suburban, and rural, and mental health status. We used t-tests to test for differences in sociodemographic characteristics across patients and performed a three-way Analyses of Variance (ANOVA) to evaluate whether the growth rates from 2013 to 2018 were different based on geography and patient type. We then estimated patient level multivariable ordinary least square regression models to estimate the relationship between the use of telemedicine and patient characteristics in 2013 and separately in 2018. Outcome was a binary variable of telemedicine use or not. Independent variables of interest include geography, age, gender, race, ethnicity, plan type, Medicare eligibility, diagnosed mental health condition, and ECI score. RESULTS Overall, Medicaid patients with a telemedicine visit grew at 81%, with rural patients growing the fastest (181%). Patients with a telemedicine visit for a mental health condition grew by 77%. Telemedicine patients with mental health diagnoses tended to have 2 to 3 more visits per year compared to non-telemedicine patients with mental health diagnoses. In 2013, multivariable regressions display that urban and suburban patients, those that had a mental health diagnosis were more likely to use telemedicine, while patients that were younger, women, Hispanics, and those dual eligible were less likely to use telemedicine. By 2018, urban and suburban patients were less likely to use telemedicine. CONCLUSIONS Growth in telemedicine care was strong in urban and rural areas between 2013 and 2018 even before the COVID-19 pandemic. Those with a mental health condition who received telemedicine care had a higher number of total mental health visits compared to those without telemedicine care. These findings hold across all geographic groups and suggest that mental health telemedicine visits did not substitute for face-to-face mental health visits.
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Affiliation(s)
- Benjamin Ukert
- Department of Health Policy and Management, Texas A&M University, College Station, TX, USA
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Hye-Chung Kum
- Population Informatics Lab, Department of Health Policy and Management, Texas A&M University, College Station, TX, USA.
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3
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Kan K, Foster C, Orionzi B, Schinasi D, Heard-Garris N. More than One Divide: A Multilevel View of the Digital Determinants of Health. J Pediatr 2024; 266:113820. [PMID: 37931700 PMCID: PMC10922486 DOI: 10.1016/j.jpeds.2023.113820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Kristin Kan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Carolyn Foster
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bako Orionzi
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dana Schinasi
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nia Heard-Garris
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Institute for Policy Research, Northwestern University, Chicago, Illinois.
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4
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Potts BA, Wood GC, Bailey-Davis L. Agreement between parent-report and EMR height, weight, and BMI among rural children. Front Nutr 2024; 11:1279931. [PMID: 38496791 PMCID: PMC10940382 DOI: 10.3389/fnut.2024.1279931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Remote anthropometric surveillance has emerged as a strategy to accommodate lapses in growth monitoring for pediatricians during coronavirus disease 2019 (COVID-19). The purpose of this investigation was to validate parent-reported anthropometry and inform acceptable remote measurement practices among rural, preschool-aged children. Methods Parent-reported height, weight, body mass index (BMI), BMI z-score, and BMI percentile for their child were collected through surveys with the assessment of their source of home measure. Objective measures were collected by clinic staff at the child's well-child visit (WCV). Agreement was assessed using correlations, alongside an exploration of the time gap (TG) between parent-report and WCV to moderate agreement. Using parent- and objectively reported BMI z-scores, weight classification agreement was evaluated. Correction equations were applied to parent-reported anthropometrics. Results A total of 55 subjects were included in this study. Significant differences were observed between parent- and objectively reported weight in the overall group (-0.24 kg; p = 0.05), as well as height (-1.8 cm; p = 0.01) and BMI (0.4 kg/m2; p = 0.02) in the ≤7d TG + Direct group. Parental reporting of child anthropometry ≤7d from their WCV with direct measurements yielded the strongest correlations [r = 0.99 (weight), r = 0.95 (height), r = 0.82 (BMI), r = 0.71 (BMIz), and r = 0.68 (BMI percentile)] and greatest classification agreement among all metrics [91.67% (weight), 54.17% (height), 83.33% (BMI), 91.67% (BMIz), and 33.33% (BMI percentile)]. Corrections did not remarkably improve correlations. Discussion Remote pediatric anthropometry is a valid supplement for clinical assessment, conditional on direct measurement within 7 days. In rural populations where socioenvironmental barriers exist to care and surveillance, we highlight the utility of telemedicine for providers and researchers.
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Affiliation(s)
| | | | - Lisa Bailey-Davis
- Center for Obesity and Metabolic Research, Geisinger Health System, Danville, PA, United States
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5
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Mitchell ES, Andrea S, Guttmann-Bauman I. Evaluating the Impact of Telemedicine Expansion on Visit Frequency for Children with Type 1 Diabetes at a Single Academic Center in Oregon. Telemed J E Health 2024; 30:415-421. [PMID: 37466483 DOI: 10.1089/tmj.2023.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Objective: The telemedicine expansion (TE) that accompanied the COVID-19 pandemic presents a novel opportunity to increase access to care for rural-residing children with type 1 diabetes (T1D) who may live a great distance from their provider. The study objective was to compare trends in visit frequency among the pediatric T1D population at a single academic center in Oregon before and after TE by those living <100 miles versus ≥100 miles from clinic (MFC) and those residing in urban versus rural areas. Research Design and Methods: We evaluated electronic health record data from 790 children receiving care between July 2018 and December 2021. We estimated differences in likelihood of adequately timed monitoring care (ATMC) over time by patient residence using Generalized Estimating Equations. Results: Just before TE, 37.3% of children were receiving ATMC and those living ≥100 MFC were 20.6% less likely to receive ATMC compared with those living <100 MFC (relative risk [RR] 0.79; confidence interval [95% CI]: 0.57-1.11). Following TE, decreases in ATMC for those living ≥100 MFC were less than for those living <100 MFC (RR of interaction: 1.17; 95% CI: 0.68-2.00). Just before TE, those living in rural areas were as likely to receive ATMC compared with those living in urban areas (RR 1.00; 95% CI: 0.61-1.63). Following TE, decreases in ATMC were greater for those living in rural areas versus urban areas (RR of interaction: 0.79; 95% CI: 0.31-2.01). Conclusions: Between July 2020 and December 2021, the likelihood of ATMC decreased across the entire pediatric T1D population. Decreases in ATMC during this period were more substantial for those living <100 MFC and/or in rural areas, however, these discrepancies were not statistically significant.
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Affiliation(s)
- Emily S Mitchell
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Sarah Andrea
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Ines Guttmann-Bauman
- Division of Endocrinology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
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Warren PW, Beck AF, Zang H, Anderson J, Statile C. Inequitable access: factors associated with incomplete referrals to paediatric cardiology. Cardiol Young 2024; 34:428-435. [PMID: 35848164 DOI: 10.1017/s1047951122002037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the variables associated with incomplete and unscheduled cardiology clinic visits among referred children with a focus on equity gaps. STUDY DESIGN We conducted a retrospective chart review for patients less than 18 years of age who were referred to cardiology clinics at a single quaternary referral centre from 2017 to 2019. We collected patient demographic data including race, an index of neighbourhood socio-economic deprivation linked to a patient's geocoded address, referral information, and cardiology clinic information. The primary outcome was an incomplete clinic visit. The secondary outcome was an unscheduled appointment. Independent associations were identified using multivariable logistic regression. RESULTS There were 10,610 new referrals; 6954 (66%) completed new cardiology clinic visits. Black race (OR 1.41; 95% CI 1.22-1.63), public insurance (OR 1.29; 95% CI 1.14-1.46), and a higher deprivation index (OR 1.32; 95% CI 1.08-1.61) were associated with higher odds of incomplete visit compared to the respective reference groups of White race, private insurance, and a lower deprivation index. The findings for unscheduled visit were similar. A shorter time elapsed from the initial referral to when the appointment was made was associated with lower odds of incomplete visit (OR 0.62; 95% CI 0.52-0.74). CONCLUSION Race, insurance type, neighbourhood deprivation, and time from referral date to appointment made were each associated with incomplete referrals to paediatric cardiology. Interventions directed to understand such associations and respond accordingly could help to equitably improve referral completion.
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Affiliation(s)
- Paul W Warren
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH 45229, USA
| | - Andrew F Beck
- General and Community Pediatrics and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Huaiyu Zang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jeffrey Anderson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Christopher Statile
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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Katzow MW, Steinway C, Zuzarte A, Chen J, Fishbein J, Jan S. Sociodemographic Disparities in Ambulatory Pediatric Telemedicine Utilization During COVID-19. Telemed J E Health 2024; 30:57-66. [PMID: 37579076 DOI: 10.1089/tmj.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Objective: Few studies have examined sociodemographic disparities in ambulatory pediatric telemedicine utilization during the coronavirus disease 2019 pandemic. We aimed to (1) assess disparities in telemedicine visit completion during the first 6 weeks of the pandemic in 2020 and (2) determine if these disparities were significantly different from those present in 2019, when all visits occurred in person. Methods: We compared sociodemographic characteristics of patients with successful versus unsuccessful telemedicine visits from March 10, 2020 to April 18, 2020, using generalized linear mixed models. We performed the same analysis for in-person visits from the same period in 2019. We tested for differences across years using interaction terms in a combined 2019-2020 model. Results: Of 3,639 telemedicine visits scheduled, 3,033 (83.3%) were successful. In 2020, Black/African American race was significantly associated with lower odds of telemedicine visit success (odds ratio 0.65 [95% confidence interval 0.49-0.87]) compared with White race, after adjusting for age, gender, ethnicity, insurance type, visit timing, visit specialty, social vulnerability index, and internet access. In 2019, racial identity other than White was significantly associated with lower odds of in-person visit success than White, as was public insurance compared with private. In the full 2019-2020 model, in-person visits (2019) had lower odds of success than telemedicine visits (2020), and neither race, insurance type, nor any other sociodemographic characteristic had significant interactions with year. Conclusions: Racial disparities were evident in telemedicine utilization early in the pandemic; however, these disparities were not significantly different from those seen in 2019, when all visits were in person. Furthermore, telemedicine may improve access to care overall, despite having no significant impact on inequity. Efforts to eliminate racial disparities in ambulatory pediatric health care utilization are necessary across visit modalities.
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Affiliation(s)
- Michelle W Katzow
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Caren Steinway
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Andrea Zuzarte
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Jack Chen
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Joanna Fishbein
- Biostatistics Unit, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Sophia Jan
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Obregon E, Ortiz R, Wallis KE, Morgan S, Montoya-Williams D. Feasibility, Acceptability, and Health Outcomes Associated With Telehealth for Children in Families With Limited English Proficiency. Acad Pediatr 2024; 24:13-22. [PMID: 37385437 PMCID: PMC10753033 DOI: 10.1016/j.acap.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Telehealth use in pediatrics increased during the COVID-19 pandemic and may improve health care access. It may also exacerbate health care disparities among families with limited English proficiency (LEP). OBJECTIVE To systematically review the feasibility, acceptability, and/or associations between telehealth delivery and health outcomes for interventions delivered synchronously in the United States. DATA SOURCES PubMed, Embase, and Scopus. STUDY ELIGIBILITY CRITERIA Original research exploring pediatric health outcomes after telehealth delivery and studies that explored the feasibility and acceptability including surveys and qualitative studies. PARTICIPANTS Patients 0 to 18 years with LEP and/or pediatric caregivers with LEP. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors independently screened abstracts, conducted full-text review, extracted information using a standardized form, and assessed study quality. A third author resolved disagreements. RESULTS Of 1831 articles identified, 9 were included in the review. Half of the studies explored videoconferencing and the other half studied health care delivered by telephone. Feasibility studies explored telehealth for children with anxiety disorders and mobile phone support for substance abuse treatment among adolescents. Acceptability studies assessed parental medical advice-seeking behaviors and caregivers' general interest in telehealth. Health outcomes studied included follow-up of home parenteral nutrition, developmental screening, and cognitive behavioral therapy. LIMITATIONS The articles were heterogeneous in approach and quality. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Telehealth appears acceptable and feasible among children in families with LEP, with a limited evidence base for specific health outcomes. We provide recommendations both for the implementation of pediatric telehealth and future research. PROSPERO REGISTRATION CRD42020204541.
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Affiliation(s)
- Evelyn Obregon
- Department of Pediatrics (E Obregon), University of Florida, Gainesville; Perinatal Institute (E Obregon), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robin Ortiz
- Department of Pediatrics and Population Health (R Ortiz), Grossman School of Medicine, New York University, New York; Institute for Excellence in Health Equity (R Ortiz), New York University, Langone Health, New York
| | - Kate E Wallis
- Division of Developmental and Behavioral Pediatrics (KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; CHOP PolicyLab (KE Wallis and D Montoya-Williams), The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pa; University of Pennsylvania Perelman School of Medicine (KE Wallis and D Montoya-Williams), Philadelphia
| | - Sherry Morgan
- University of Pennsylvania (S Morgan), Holman Biotech Commons, Robert Wood Johnson Pavilion, Philadelphia
| | - Diana Montoya-Williams
- CHOP PolicyLab (KE Wallis and D Montoya-Williams), The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pa; University of Pennsylvania Perelman School of Medicine (KE Wallis and D Montoya-Williams), Philadelphia; Division of Neonatology (D Montoya-Williams), The Children's Hospital of Philadelphia, Philadelphia, Pa.
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Kronforst K, Barrera L, Casale M, Smith TL, Schinasi D, Macy ML. Pediatric Telehealth Access and Utilization in Chicago During the First Year of the COVID-19 Pandemic. Telemed J E Health 2023; 29:1324-1331. [PMID: 36730746 PMCID: PMC10468546 DOI: 10.1089/tmj.2022.0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The COVID-19 pandemic demanded rapid development of telemedicine services for pediatric care and highlighted disparities for marginalized communities. Objective: To understand the demographic characteristics of patients with completed and incomplete telemedicine visits at Ann and Robert H. Lurie Children's Hospital of Chicago. Methods: This was a cross-sectional retrospective analysis of telemedicine visits for patients <25 years old scheduled between March 21, 2020, and March 17, 2021. We examined visit outcomes and compared outcomes by race/ethnicity, language, and payer using logistic regression. Geographic information system mapping and linear regression were used to examine the relationship between incomplete visits and broadband access within Cook County. Results: A total of 13,655 eligible video visits were scheduled for children within 147 ZIP codes during the study time frame. Patient characteristics included median age 9 years, 53% female, 42% non-Latinx White, 31% Latinx, 13% non-Latinx Black, 11% non-Latinx other, and 3% declined/unknown. Preferred language was 89% English, 10% Spanish, and 1% other. Payer was 56% private, 43% public, and <1% other/self-pay. Overall, 86% video visits were completed, 7% cancelled, and 7% no-show with significant variation by patient demographic. Odds of incomplete visits were higher for Latinx patients (odds ratio [OR] 1.93) and non-Latinx Black patients (OR 2.33) than for non-Latinx White patients, patients with preferred language other than English (OR 1.53), and patients not privately insured (OR 1.89). Incomplete visit rates and broadband access were inversely related. Conclusion: System and policy solutions are needed to ensure equitable access and address disparities in incomplete telemedicine visits for marginalized populations in urban areas with lower broadband.
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Affiliation(s)
- Kenny Kronforst
- Department of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Telehealth and Digital Health Programs, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Leonardo Barrera
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Mia Casale
- Department of Data Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Tracie L. Smith
- Department of Data Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Dana Schinasi
- Telehealth and Digital Health Programs, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michelle L. Macy
- Telehealth and Digital Health Programs, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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10
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Haynes SC, Marcin JP, Dayal P, Tancredi DJ, Crossen S. Impact of telemedicine on visit attendance for paediatric patients receiving endocrinology specialty care. J Telemed Telecare 2023; 29:126-132. [PMID: 33226895 PMCID: PMC8141067 DOI: 10.1177/1357633x20972911] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Children in rural communities often lack access to subspecialty medical care. Telemedicine has the potential to improve access to these services but its effectiveness has not been rigorously evaluated for paediatric patients with endocrine conditions besides diabetes. INTRODUCTION The purpose of this study was to assess the association between telemedicine and visit attendance among patients who received care from paediatric endocrinologists at an academic medical centre in northern California between 2009-2017. METHODS We abstracted demographic data, encounter information and medical diagnoses from the electronic health record for patients ≤18 years of age who attended at least one in-person or telemedicine encounter with a paediatric endocrinologist during the study period. We used a mixed effects logistic regression model - adjusted for age, diagnosis and distance from subspecialty care - to explore the association between telemedicine and visit attendance. RESULTS A total of 40,941 encounters from 5083 unique patients were included in the analysis. Patients who scheduled telemedicine visits were predominantly publicly insured (97%) and lived a mean distance of 161 miles from the children's hospital. Telemedicine was associated with a significantly higher odds of visit attendance (odds ratio 2.55, 95% confidence interval 2.15-3.02, p < 0.001) compared to in-person care. CONCLUSIONS This study demonstrates that telemedicine is associated with higher odds of visit attendance for paediatric endocrinology patients and supports the conclusion that use of telemedicine may improve access to subspecialty care for rural and publicly insured paediatric populations.
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Affiliation(s)
- Sarah C Haynes
- Department of Pediatrics, University of California Davis, USA,Center for Health and Technology, University of California Davis, USA
| | - James P Marcin
- Department of Pediatrics, University of California Davis, USA,Center for Health and Technology, University of California Davis, USA
| | - Parul Dayal
- Center for Health and Technology, University of California Davis, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis, USA,Center for Healthcare Policy and Research, University of California Davis, USA
| | - Stephanie Crossen
- Department of Pediatrics, University of California Davis, USA,Center for Health and Technology, University of California Davis, USA
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11
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Schweiberger K, Verma R, Faulds S, Jonassaint CR, White GE, Ray KN. Scheduled and attended pediatric primary care telemedicine appointments during COVID-19. Pediatr Res 2023:10.1038/s41390-023-02481-w. [PMID: 36690746 PMCID: PMC9869302 DOI: 10.1038/s41390-023-02481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of this study was to examine pediatric primary care telemedicine visit scheduling and attendance during the first year of telemedicine. METHODS Using electronic health record data from two academic pediatric primary care practices between April 2020-March 2021, we used Pearson χ2 tests and logistic regression models to identify child-, family-, and appointment-level characteristics associated with scheduled and attended telemedicine appointments. RESULTS Among 5178 primary care telemedicine appointments scheduled during the 12-month period, the proportion of appointments scheduled differed over time for children in families with a language preference other than English or Spanish (4% quarter 1 vs. 6% in quarter 4, p = 0.01) and residing in ZIP codes with the lowest household technology access (24% in quarter 1 vs. 19% in quarter 3 (p = 0.01). Four thousand one hundred and forty-eight of 5178 scheduled telemedicine appointments were attended. Likelihood of attending a telemedicine appointment was highest for children in families with a language preference other than English or Spanish (90%, 95% CI 86-94% compared to Spanish 74%, 95% CI 65-84%), and same-day appointments (86%, 95% CI 85-87%). Attendance among families preferring Spanish language was higher in later months compared to earlier months. CONCLUSIONS We found disparities in scheduling and attending telemedicine appointments, but signs of greater language equity over time.
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Affiliation(s)
- Kelsey Schweiberger
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Avenue, CHOB 1st Floor, Pittsburgh, PA, 15213, USA.
| | - Rhea Verma
- grid.21925.3d0000 0004 1936 9000Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Avenue, CHOB 1st Floor, Pittsburgh, PA 15213 USA
| | - Samantha Faulds
- grid.21925.3d0000 0004 1936 9000Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Avenue, CHOB 1st Floor, Pittsburgh, PA 15213 USA
| | - Charles R. Jonassaint
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Gretchen E. White
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Kristin N. Ray
- grid.21925.3d0000 0004 1936 9000Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Avenue, CHOB 1st Floor, Pittsburgh, PA 15213 USA
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12
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Fiks AG, Frintner MP, Gottschlich EA, Ray KN. Pediatricians' Experiences With Telehealth in 2021. Pediatrics 2022; 150:189934. [PMID: 36366926 DOI: 10.1542/peds.2022-059306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
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13
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Schweiberger K, Bohnhoff J, Hanmer J, Ray KN. Perceived Usefulness of Increased Telemedicine Use by Pediatric Subspecialists: A National Survey. Telemed J E Health 2022; 28:1367-1373. [PMID: 35143360 PMCID: PMC10039272 DOI: 10.1089/tmj.2021.0583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/08/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Although many studies have explored the perceived ease-of-use of telemedicine, the perceived usefulness of telemedicine for pediatric subspecialty care is less clear. Methods: We invited a national sample of 840 general pediatricians and 840 pediatric subspecialists to participate in a survey fielded in May-June 2020. Respondents ranked perceptions of usefulness of telemedicine for pediatric subspecialty care on a 5-point Likert scale and prioritization of potential strategies to support telemedicine use on a 4-point scale. Results: Of 285 respondents (18% response rate), physicians perceived that increased telemedicine use by pediatric subspecialists would modestly improve child health (mean = 3.5, standard deviation [SD] = 0.7), and access to care (mean = 3.9, SD = 0.6), but would slightly worsen the clinician experience (mean = 2.8, SD = 0.8). Most respondents highly prioritized payment-related strategies to support use of telemedicine. Conclusions: Pediatric clinicians anticipated that increased telemedicine use by pediatric subspecialists would improve child health and health care access but would worsen clinician experience.
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Affiliation(s)
- Kelsey Schweiberger
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Bohnhoff
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janel Hanmer
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kristin N. Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Shouman S, Emara T, Saber HG, Allam MF. Awareness and attitude of primary healthcare patients towards telehealth in Cairo, Egypt. Curr Med Res Opin 2022; 38:993-998. [PMID: 35404179 DOI: 10.1080/03007995.2022.2065141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Telehealth is delivering health care services remotely from healthcare facilities using telecommunications and virtual technology. Egypt is aiming to reach Universal Health Coverage; this increases the demand for telehealth in routine health services. Telehealth helps in increasing access to areas with no available medical services as patients can be monitored remotely. OBJECTIVE To measure the awareness of telehealth among attendees of primary health care units and their acceptance of applying telehealth. METHODOLOGY This was a cross-sectional study among attendees of primary health units. Ethical issues were considered. RESULTS A sample size was calculated to be 162 and 170 valid Arabic interview questionnaires were filled by attendees. The awareness percentage of telehealth among attendees was 64.7% while the willingness to implement telehealth was 78%. Both awareness and willingness were significantly associated with age groups, residence, socioeconomic status, and presence of computer with internet access. Age, residence, and possession of a PC were the only adjusted predictive factors for knowledge about telehealth among patients in the multivariable analysis. CONCLUSION Large percentages of attendees to primary health care centers are aware of telehealth and are willing to implement it. The major cause of refusal to implement telehealth was ignorance of using telecommunication devices and the desire to be in close contact with the physicians.
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Affiliation(s)
- Sara Shouman
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Emara
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Gamal Saber
- Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Farouk Allam
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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15
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Dougherty D, Thompson AR, Speck KE, Perrone EE. Preoperative virtual video visits only: a convenient option that should be offered to caregivers beyond the pandemic. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000403. [DOI: 10.1136/wjps-2021-000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/23/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectiveDuring the COVID-19 pandemic, our group implemented preoperative video visits (VVs) to limit physical contact. The aim of this study was to determine caregivers’ and providers’ perceptions of this practice and to determine feasibility for continuation.MethodsAll patients who had only a preoperative VV prior to an elective surgery were identified from March–October 2020. Caregivers, surgeons, and clinic staff were surveyed about their experiences.ResultsThirty-four preoperative VVs were followed by an elective surgery without a preceding in-person visit. Of the 31 caregiver surveys completed, the majority strongly agreed that the VV was more convenient (87%, n=27). Eighty-one percent (n=25) strongly agreed or agreed that the VV saved them money. Ninety-four percent (n=29) strongly agreed or agreed that they would choose the VV option again. Caregivers saved an average travel distance of 60.3 miles one way (range 6.1–480). Of the 13/17 providers who responded, 77% (n=10) expressed that the practice should continue.ConclusionsVirtual health became a necessity during the pandemic, and caregivers were overwhelmingly satisfied. Continuing VVs as an option beyond the pandemic may be a reasonable and effective way to help eliminate some of the hurdles that impede healthcare-seeking behavior and should be offered.
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Javier-DesLoges J, Meagher M, Soliman S, Yuan J, Hakimi K, Ghali F, Nalawade V, Patel DN, Monga M, Murphy JD, Derweesh I. Disparities in Telemedicine Utilization for Urology Patients During the COVID-19 Pandemic. Urology 2022; 163:76-80. [PMID: 34979219 PMCID: PMC8719918 DOI: 10.1016/j.urology.2021.11.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the odds of accessing telemedicine either by phone or by video during the COVID-19 pandemic. METHODS We performed a retrospective study of patients who were seen at a single academic institution for a urologic condition between March 15, 2020 and September 30, 2020. The primary outcome was to determine characteristics associated with participating in a telemedicine appointment (video or telephone) using logistic regression multivariable analysis. We used a backward model selection and variables that were least significant were removed. We adjusted for reason for visit, patient characteristics such as age, sex, ethnicity, race, reason for visit, preferred language, and insurance. Variables that were not significant that were removed from our final model included median income estimated by zip code, clinic location, provider age, provider sex, and provider training. RESULTS We reviewed 4234 visits: 1567 (37%) were telemedicine in the form of video 1402 (33.1%) or telephone 164 (3.8%). The cohort consisted of 2516 patients, Non-Hispanic White (n = 1789, 71.1%) and Hispanic (n = 417, 16.6%). We performed multivariable logistic regression analysis and demonstrated that patients who were Hispanic, older, or had Medicaid insurance were significantly less likely to access telemedicine during the pandemic. We did not identify differences in telemedicine utilization when stratifying providers by their age, sex, or training type (physician or advanced practice provider). CONCLUSION We conclude that there are differences in the use of telemedicine and that this difference may compound existing disparities in care. Additionally, we identified that these differences were not associated with provider attributes. Further study is needed to overcome barriers in access to telemedicine.
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Affiliation(s)
| | - Margaret Meagher
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Shady Soliman
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Julia Yuan
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Fady Ghali
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, La Jolla, CA
| | - Devin N Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Manoj Monga
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, La Jolla, CA
| | - Ithaar Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA.
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Callison K, Anderson A, Shao Y, LaVeist TA, Walker B. Pre-COVID-19 Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries. Telemed J E Health 2022; 28:1698-1703. [PMID: 35297687 DOI: 10.1089/tmj.2022.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: We examine trends in telemedicine use by race, geography, and age among Louisiana Medicaid beneficiaries in the months preceding the COVID-19 pandemic. Methods: Using Louisiana Medicaid claims data from January 2018 through February 2020, we calculated a relative ratio of telemedicine use as the share of telemedicine claims by race, age, and geography and conducted two-sample t-tests. Results: In 2018, White beneficiaries used telemedicine at a relative ratio of 1.92 compared with Black beneficiaries (p < 0.001) and 2.02 compared with Hispanic beneficiaries (p < 0.001). Rural beneficiaries used telemedicine at a relative ratio of 1.27 (p < 0.001) compared with urban beneficiaries. Children and adolescents used telemedicine at a higher rate than other age groups. Racial and geographic disparities narrowed in the first months of 2020. Conclusions: Telemedicine use in Louisiana Medicaid was low but growing before the pandemic with narrowing disparities by race and geography and emerging disparities by age.
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Affiliation(s)
- Kevin Callison
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Andrew Anderson
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yixue Shao
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Thomas A LaVeist
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Brigham Walker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Real World Data and Technology, ConcertAI, Boston, Massachusetts, USA
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Uscher-Pines L, McCullough C, Dworsky MS, Sousa J, Predmore Z, Ray K, Magit A, Rivanis C, Lerner C, Iwakoshi J, Barkley S, Marcin JP, McGuire T, Browne MA, Swanson C, Cleary JP, Kelly E, Layton K, Schulson L. Use of Telehealth Across Pediatric Subspecialties Before and During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e224759. [PMID: 35357455 PMCID: PMC8972035 DOI: 10.1001/jamanetworkopen.2022.4759] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE The identification of variation in health care is important for quality improvement. Little is known about how different pediatric subspecialties are using telehealth and what is driving variation. OBJECTIVE To characterize trends in telehealth use before and during the COVID-19 pandemic across pediatric subspecialties and the association of delivery change with no-show rates and access disparities. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, 8 large pediatric medical groups in California collaborated to share aggregate data on telehealth use for 11 pediatric subspecialties from January 1, 2019, to December 31, 2021. MAIN OUTCOMES AND MEASURES Monthly in-person and telehealth visits for 11 subspecialties, characteristics of patients participating in in-person and telehealth visits, and no-show rates. Monthly use rates per 1000 unique patients were calculated. To assess changes in no-show rates, a series of linear regression models that included fixed effects for medical groups and calendar month were used. The demographic characteristics of patients served in person during the prepandemic period were compared with those of patients who received in-person and telehealth care during the pandemic period. RESULTS In 2019, participating medical groups conducted 1.8 million visits with 549 306 unique patients younger than 18 years (228 120 [41.5%] White and 277 167 [50.5%] not Hispanic). A total of 72 928 patients (13.3%) preferred a language other than English, and 250 329 (45.6%) had Medicaid. In specialties with lower telehealth use (cardiology, orthopedics, urology, nephrology, and dermatology), telehealth visits ranged from 6% to 29% of total visits from May 1, 2020, to April 30, 2021. In specialties with higher telehealth use (genetics, behavioral health, pulmonology, endocrinology, gastroenterology, and neurology), telehealth constituted 38.8% to 73.0% of total visits. From the prepandemic to the pandemic periods, no-show rates slightly increased for lower-telehealth-use subspecialties (9.2% to 9.4%) and higher-telehealth-use subspecialties (13.0% to 15.3%), but adjusted differences (comparing lower-use and higher-use subspecialties) in changes were not statistically significant (difference, 2.5 percentage points; 95% CI, -1.2 to 6.3 percentage points; P = .15). Patients who preferred a language other than English constituted 6140 in-person visits (22.2%) vs 2707 telehealth visits (11.4%) in neurology (P < .001). CONCLUSIONS AND RELEVANCE There was high variability in adoption of telehealth across subspecialties and in patterns of use over time. The documentation of variation in telehealth adoption can inform evolving telehealth policy for pediatric patients, including the appropriateness of telehealth for different patient needs and areas where additional tools are needed to promote appropriate use.
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Affiliation(s)
| | | | | | | | | | - Kristin Ray
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony Magit
- Rady Children’s Hospital San Diego, San Diego, California
| | - Chris Rivanis
- Children’s Hospital Orange County, Orange, California
| | - Carlos Lerner
- UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Joy Iwakoshi
- Loma Linda University Health, Loma Linda, California
| | - Steven Barkley
- Cottage Children's Medical Center, Santa Barbara, California
| | | | - Troy McGuire
- Children’s Hospital Los Angeles, Los Angeles, California
| | | | - Craig Swanson
- Sutter Children’s Medical Center, Sacramento, California
| | | | - Erin Kelly
- Sutter Children’s Medical Center, Sacramento, California
- Children’s Specialty Care Coalition, Sacramento, California
| | - Katie Layton
- Children’s Specialty Care Coalition, Sacramento, California
| | - Lucy Schulson
- RAND Corporation, Arlington, Virginia
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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19
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Pediatric subspecialty telemedicine use from the patient and provider perspective. Pediatr Res 2022; 91:241-246. [PMID: 33753896 PMCID: PMC7984505 DOI: 10.1038/s41390-021-01443-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To characterize telemedicine use among pediatric subspecialties with respect to clinical uses of telemedicine, provider experience, and patient perceptions during the COVID-19 pandemic. METHODS We performed a mixed-methods study of telemedicine visits across pediatric endocrinology, nephrology, orthopedic surgery, and rheumatology at a large children's hospital. We used deductive analysis to review observational data from 40 video visits. Providers and patients/caregivers were surveyed around areas of satisfaction and communication. RESULTS We found adaptations of telemedicine including shared-screen use and provider-guided parent procedures among others. All providers felt that it was safest for their patients to conduct visits by video, and 72.7% reported completing some component of a clinical exam. Patients rated the areas of being respected by the clinical staff/provider and showing care and concern highly, and the mean overall satisfaction was 86.7 ± 19.3%. CONCLUSIONS Telemedicine has been used to deliver care to pediatric patients during the pandemic, and we found that patients were satisfied with the telemedicine visits during this stressful time and that providers were able to innovate during visits. Telemedicine is a tool that can be successfully adapted to patient and provider needs, but further studies are needed to fully explore its integration in pediatric subspecialty care. IMPACT This study describes telemedicine use at the height of the COVID-19 pandemic from both a provider and patient perspective, in four different pediatric subspecialties. Prior to COVID-19, pediatric telehealth landscape analysis suggested that many pediatric specialty practices had pilot telehealth programs, but there are few published studies evaluating telemedicine performance through the simultaneous patient and provider experience as part of standard care. We describe novel uses and adaptations of telemedicine during a time of rapid deployment in pediatric specialty care.
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Abstract
Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.
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Affiliation(s)
- Richard Taylor
- Pediatric Residency Program, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 5018, Cincinnati, OH 45229, USA
| | - Daniel Mallon
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2010, Cincinnati, OH 45229, USA.
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21
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Gan Z, Lee SY, Weiss DA, Van Batavia J, Siu S, Frazier J, Zderic SA, Shukla AR, Srinivasan AK, Kolon TF, Zaontz MR, Canning DA, Long CJ. Single institution experience with telemedicine for pediatric urology outpatient visits: Adapting to COVID-19 restrictions, patient satisfaction, and future utilization. J Pediatr Urol 2021; 17:480.e1-480.e7. [PMID: 34078574 PMCID: PMC8491551 DOI: 10.1016/j.jpurol.2021.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/30/2021] [Accepted: 05/09/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Widespread utilization of telemedicine in our practice to date has been limited to the evaluation of certain post-surgical patients. The COVID-19 pandemic acutely stressed our established system and required us to enhance our utilization of telemedicine. We hypothesized that expansion of telemedicine to new and follow up patient visits for pediatric urology could be done effectively in a way that satisfied patient and parental expectations. MATERIALS AND METHODS Using a pre-COVID-19 established telemedicine program based in our electronic medical record (EMR), patients and providers transitioned to primarily virtual visits when clinically appropriate. Guidelines were formulated to direct patient scheduling, provider and staff education was provided, including a process map designed for multiple providers to complete video visits (VV), and the EMR was redesigned to incorporate telehealth terminology. The number of VV per provider was recorded using the electronic medical record, and patient reported outcomes (PRO) were measured using a standardized questionnaire. RESULTS A total of 631 VV met inclusion criteria during the period of May 2018-April 2020. This included 334 follow up, 172 new, and 125 postoperative visits. The median age of patients at time of visit was 7 years (IQR 2-12 years), median visit time was 20 min (IQR 15-30 min), and the median travel distance saved by performing a VV was 12.2 miles (IQR 6.3-26.8 miles). Diagnoses were varied and included the entire breadth of a standard pediatric urology practice. The PRO questionnaire was completed for 325 of those patient visits. Families reported a high overall satisfaction with the video visits (median score of 10 out of 10) and felt that the visit met their child's medical needs. 90% stated that they would strongly recommend a telehealth visit to other families. Patients and parents reported benefits of VV including decreased travel costs and less time taken off from work and school. CONCLUSION The EMR enabled nimble redirection of clinical care in the setting of a global pandemic. The enhanced use of telemedicine has proved to be an alternative method to provide care for pediatric urology patients. Families indicate a high degree of satisfaction with this technology in addition to significant time and cost savings. Telemedicine should remain a key aspect of medical care and expanded from post-operative visits to new patient and follow up visits, even as we return to our normal practices as the pandemic restrictions soften.
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Affiliation(s)
- Zoe Gan
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Seo Young Lee
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Jason Van Batavia
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Sharmayne Siu
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Jennifer Frazier
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephen A Zderic
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Aseem R Shukla
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Arun K Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Thomas F Kolon
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Mark R Zaontz
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Douglas A Canning
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christopher J Long
- Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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22
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Michel HK, Maltz RM, Boyle B, Donegan A, Dotson JL. Applying Telemedicine to Multidisciplinary Pediatric Inflammatory Bowel Disease Care. CHILDREN-BASEL 2021; 8:children8050315. [PMID: 33919417 PMCID: PMC8143311 DOI: 10.3390/children8050315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 12/13/2022]
Abstract
Multidisciplinary care is essential to the delivery of comprehensive, whole-person care for children and adolescents with inflammatory bowel disease (IBD). Team members may include medical, psychosocial, and ancillary providers as well as patient and family advocates. There is significant variability in how this care is delivered from center to center, though prior to the COVID-19 pandemic, most care occurred during in-person visits. At the onset of the pandemic, medical systems world-wide were challenged to continue delivering high quality, comprehensive care, requiring many centers to turn to telemedicine technology. The aim of this manuscript is to describe the process by which we converted our multidisciplinary pediatric and adolescent IBD visits to a telemedicine model by leveraging technology, a multidisciplinary team, and quality improvement (QI) methods. Finally, we put our experience into context by summarizing the literature on telemedicine in IBD care, with a focus on pediatrics and multidisciplinary care.
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Affiliation(s)
- Hilary K. Michel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Correspondence:
| | - Ross M. Maltz
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for Microbial Pathogenesis, The Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Brendan Boyle
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Amy Donegan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jennifer L. Dotson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for Innovation in Pediatric Practice, Nationwide Children’s Hospital, Columbus, OH 43205, USA
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23
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Xiang XM, Bernard J. Telehealth in Multiple Sclerosis Clinical Care and Research. Curr Neurol Neurosci Rep 2021; 21:14. [PMID: 33646409 PMCID: PMC7917521 DOI: 10.1007/s11910-021-01103-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/21/2022]
Abstract
Purpose of Review The COVID-19 pandemic has provided us with a unique opportunity to experiment with telehealth and evaluate its benefits and limitations. This review discusses the impact of telehealth on multiple sclerosis (MS) care and research in adults and children. Recent Findings Telehealth visits for MS patients have been shown to reduce missed workdays and costs for patients. Brief telephone-based counseling may be associated with better adherence to disease-modifying therapy, although results of multiple home-based tele-rehabilitation for people with MS have been equivocal. Overall, patients and providers have reported high levels of satisfactions with telehealth. Several remote disability measures and numerous other technological tools have emerged for use in remote MS research and care. Major challenges of telehealth include limitations to performing a complete neurologic exam and disparities in access to telehealth amongst vulnerable populations with limited access to virtual platforms. Summary Following the rapid expansion of telehealth during the pandemic, it is highly likely that we will continue to embrace the benefits of this valuable tool. Future directions for improving telehealth should include more evidence-based research on the diagnostic accuracy in neuroimmunology and reducing disparities in the access to telehealth.
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Affiliation(s)
- Xinran Maria Xiang
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L226, Portland, OR, 97239, USA.
| | - Jacqueline Bernard
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L226, Portland, OR, 97239, USA
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24
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Lott A, Sacks H, Hutzler L, Campbell KA, Lajam CM. Telemedicine Utilization by Orthopedic Patients During COVID-19 Pandemic: Demographic and Socioeconomic Analysis. Telemed J E Health 2021; 27:1117-1122. [PMID: 33448896 DOI: 10.1089/tmj.2020.0425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The relaxation of telemedicine (TM) restrictions during the COVID-19 pandemic accelerated adoption of this technology by many orthopedic practices. The purpose of this study was to examine the demographics of the orthopedic patients who utilized TM visits during the COVID-19 pandemic to identify opportunities to improve access. Methods: All patients who underwent orthopedic TM visits at one urban academic medical center between January and April 2020 were included. Demographic data including primary zip code, primary language, and visit type were collected. The demographics of the TM cohort were compared with those of patients seen in the outpatient (OP) setting at the same institution the prior year as well as with patients in the metropolitan area (M). Results: Five thousand thirty-five TM visits met the inclusion criteria. The TM cohort was significantly younger than the OP cohort, with mean age of 48.7 ± 19.0 years for TM and 55.2 ± 18.0 years for OP, and with 22% of TM being 65 or older versus 35% of OP being 65 or older (p = 0.001). The TM cohort had a lower percentage of minority patients (41.3%) than the OP cohort (48.2%). The TM cohort had a significantly lower percentage of black 12.9% versus 14.1%, Asian. 5.1% versus 5.8%, and Spanish/Hispanic 1.9% versus 15.4%, than the M and the OP cohort from the prior year (p < 0.026, p < 0.001, p < 0.001). For socioeconomic status, only 13.8% of TM patients were from ZIP codes with median household incomes <50k. A total of 96.2% of TM visits were performed in English, where only 61% of individuals in the metropolitan area report English as their primary language. Conclusions: As the largest analysis of the use of TM in orthopedics, this study highlights both the future potential of TM and areas of improvement to ensure better access to care for all patient populations. Maintenance of the provisions to allow audio-only visits to be considered TM and billed as such is one important measure.
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Affiliation(s)
- Ariana Lott
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Hayley Sacks
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Lorraine Hutzler
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Claudette M Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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25
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Xie J, Prahalad P, Lee TC, Stevens LA, Meister KD. Pediatric Subspecialty Adoption of Telemedicine Amidst the COVID-19 Pandemic: An Early Descriptive Analysis. Front Pediatr 2021; 9:648631. [PMID: 33928058 PMCID: PMC8076568 DOI: 10.3389/fped.2021.648631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Telemedicine has rapidly expanded in many aspects of pediatric care as a result of the COVID-19 pandemic. However, little is known about what factors may make pediatric subspeciality care more apt to long-term adoption of telemedicine. To better delineate the potential patient, provider, and subspecialty factors which may influence subspecialty adoption of telemedicine, we reviewed our institutional experience. The top 36 pediatric subspecialties at Stanford Children's Health were classified into high telemedicine adopters, low telemedicine adopters, and telemedicine reverters. Distance from the patient's home, primary language, insurance type, institutional factors such as wait times, and subspecialty-specific clinical differences correlated with differing patterns of telemedicine adoption. With greater awareness of these factors, institutions and providers can better guide patients in determining which care may be best suited for telemedicine and develop sustainable long-term telemedicine programming.
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Affiliation(s)
- James Xie
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States.,Information Services Department, Stanford Children's Health, Stanford, CA, United States
| | - Priya Prahalad
- Information Services Department, Stanford Children's Health, Stanford, CA, United States.,Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Tzielan C Lee
- Information Services Department, Stanford Children's Health, Stanford, CA, United States.,Division of Pediatric Rheumatology, Department of Pediatrics, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Lindsay A Stevens
- Information Services Department, Stanford Children's Health, Stanford, CA, United States.,Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Kara D Meister
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, CA, United States
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26
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Macy ML, Leslie LK, Turner A, Freed GL. Growth and changes in the pediatric medical subspecialty workforce pipeline. Pediatr Res 2021; 89:1297-1303. [PMID: 33328583 PMCID: PMC7738773 DOI: 10.1038/s41390-020-01311-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND To inform discussions of pediatric subspecialty workforce adequacy and characterize its pipeline, we examined trends in first-year fellows in the 14 American Board of Pediatrics (ABP)-certified pediatric medical subspecialties, 2001-2018. METHODS Data were obtained from the ABP Certification Management System. We determined, within each subspecialty, the annual number of first-year fellows. We assessed for changes in the population using variables available throughout the study period (gender, medical school location, program region, and program size). We fit linear trendlines and calculated χ2 statistics. RESULTS The number of first-year pediatric medical subspecialty fellows increased from 751 in 2001 to 1445 in 2018. Fields with the growth of 3 or more fellows per year were Cardiology, Critical Care, Emergency Medicine, Gastroenterology, Neonatology, and Hematology Oncology (P value <0.05 for all). The number of fellows entering Adolescent Medicine, Child Abuse, Infectious Disease, and Nephrology increased at a rate of 0.5 fellows or fewer per year. Female American Medical Graduates represented the largest and growing proportions of several subspecialties. Distribution of programs by region and size were relatively consistent over time, but varied across subspecialties. CONCLUSIONS The number of pediatricians entering medical subspecialty fellowship training is uneven and patterns of growth differ between subspecialties. IMPACT The number of individuals entering fellowship training has increased between 2001 and 2018. Growth in the number of first-year fellows is uneven. Fields with the greatest growth: Critical Care, Emergency Medicine, and Neonatology. Fields with limited growth: Adolescent Medicine, Child Abuse, Infectious Disease, and Nephrology. Concerns about the pediatric medical subspecialty workforce are not explained by the number of individuals entering the fellowship.
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Affiliation(s)
- Michelle L. Macy
- Child Health Evaluation and Research (CHEAR) Center, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Emergency Medicine, University of Michigan, Ann Arbor, MI USA ,grid.413808.60000 0004 0388 2248Present Address: Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine Northwestern University, Chicago, IL USA
| | - Laurel K. Leslie
- American Board of Pediatrics, Chapel Hill, NC USA ,grid.67033.310000 0000 8934 4045Tufts Medical Center/School of Medicine, Boston, MA USA
| | - Adam Turner
- American Board of Pediatrics, Chapel Hill, NC USA
| | - Gary L. Freed
- Child Health Evaluation and Research (CHEAR) Center, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of PediatricsDivision of General Pediatrics, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Health Management and Policy, University of Michigan, Ann Arbor, MI USA
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27
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Gilson SF, Umscheid CA, Laiteerapong N, Ossey G, Nunes KJ, Shah SD. Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis. JMIR Med Inform 2020; 8:e24544. [PMID: 33191247 PMCID: PMC7721629 DOI: 10.2196/24544] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. Objective The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. Methods We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. Results Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. Conclusions Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.
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Affiliation(s)
- Sarah F Gilson
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Craig A Umscheid
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Graeme Ossey
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States.,Digital Health, University of Chicago Medicine, Chicago, IL, United States
| | - Kenneth J Nunes
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, United States
| | - Sachin D Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States.,Department of Pediatrics, University of Chicago, Chicago, IL, United States
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28
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Mehta P, Braskett M, Tam JS, Espinoza J. Reimbursement patterns and user experiences in pediatric allergy home telehealth. Ann Allergy Asthma Immunol 2020; 125:693-698.e1. [PMID: 32526378 PMCID: PMC7280098 DOI: 10.1016/j.anai.2020.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Telehealth use has been increasing during the last decade. Studies have found that patients have a positive attitude toward incorporating telehealth into their health care. Substantial uncertainty remains regarding reimbursement policies that vary widely between states and by payer. OBJECTIVE To explore the clinical, operational, and financial feasibility of a home telehealth (HTH) program in a pediatric allergy and immunology clinic. METHODS Allergy and immunology physicians defined use cases they deemed appropriate for HTH appointments. Established patients in the allergy and immunology clinic were approached to complete an attitudes and perception survey. Patients who met the use case definitions were asked to participate in the pilot program. After their HTH appointment took place, they completed a validated satisfaction survey. Our institution's revenue cycle management team provided reimbursement data. RESULTS Patient attitudes toward HTH were generally favorable. A total of 51 HTH appointments were offered, and 46 appointments were made. Notably, 37 appointments were completed successfully among 32 unique patients. Patients were satisfied with the HTH experience. A total of 36 of 37 encounters were reimbursed by 19 different public and private payers. Payers on average reimbursed ±6% of the expected allowable for an equivalent in-person visit. CONCLUSION Patients had reservations about HTH initially but were satisfied with their experience. Private and public payers reimbursed HTH the same as in-person appointments. Here, we report that HTH is well accepted by patients and is financially viable.
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Affiliation(s)
- Preeya Mehta
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Melinda Braskett
- Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan S Tam
- Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Juan Espinoza
- Keck School of Medicine, University of Southern California, Los Angeles, California; Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.
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29
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Mehta B, Jannat-Khah D, Fontana MA, Moezinia CJ, Mancuso CA, Bass AR, Antao VC, Gibofsky A, Goodman SM, Ibrahim S. Impact of COVID-19 on vulnerable patients with rheumatic disease: results of a worldwide survey. RMD Open 2020; 6:rmdopen-2020-001378. [PMID: 33011680 PMCID: PMC7722380 DOI: 10.1136/rmdopen-2020-001378] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE There is emerging evidence that COVID-19 disproportionately affects people from racial/ethnic minority and low socioeconomic status (SES) groups. Many physicians across the globe are changing practice patterns in response to the COVID-19 pandemic. We sought to examine the practice changes among rheumatologists and what they perceive the impact to be on their most vulnerable patients. METHODS We administered an online survey to a convenience sample of rheumatologists worldwide during the initial height of the pandemic (between 8 April and 4 May 2020) via social media and group emails. We surveyed rheumatologists about their opinions regarding patients from low SES and racial/ethnic minority groups in the context of the COVID-19 pandemic. Mainly, what their specific concerns were, including the challenges of medication access; and about specific social factors (health literacy, poverty, food insecurity, access to telehealth video) that may be complicating the management of rheumatologic conditions during this time. RESULTS 548 rheumatologists responded from 64 countries and shared concerns of food insecurity, low health literacy, poverty and factors that preclude social distancing such as working and dense housing conditions among their patients. Although 82% of rheumatologists had switched to telehealth video, 17% of respondents estimated that about a quarter of their patients did not have access to telehealth video, especially those from below the poverty line. The majority of respondents believed these vulnerable patients, from racial/ethnic minorities and from low SES groups, would do worse, in terms of morbidity and mortality, during the pandemic. CONCLUSION In this sample of rheumatologists from 64 countries, there is a clear shift in practice to telehealth video consultations and widespread concern for socially and economically vulnerable patients with rheumatic disease.
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Affiliation(s)
- Bella Mehta
- Hospital for Special Surgery, New York, New York, USA .,Weill Cornell Medical College, New York, New York, USA
| | - Deanna Jannat-Khah
- Hospital for Special Surgery, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | | | | | - Carol A Mancuso
- Hospital for Special Surgery, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Anne R Bass
- Hospital for Special Surgery, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | | | - Allan Gibofsky
- Hospital for Special Surgery, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Susan M Goodman
- Hospital for Special Surgery, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Said Ibrahim
- Weill Cornell Medical College, New York, New York, USA
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30
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Schaumberg L. Advanced Practice Telenursing Through a Pandemic. J Psychosoc Nurs Ment Health Serv 2020; 58:4-6. [DOI: 10.3928/02793695-20200624-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Laurie Schaumberg
- Advanced Practice Nurse Prescriber, Brown County Child and Adolescent, Behavior Unit, Green Bay, Wisconsin
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31
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Badawy SM, Radovic A. Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research. JMIR Pediatr Parent 2020; 3:e20049. [PMID: 32540841 PMCID: PMC7318926 DOI: 10.2196/20049] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)-secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts.
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Affiliation(s)
- Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ana Radovic
- Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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32
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Sukhov R, Asante A, Ilizarov G. Telemedicine for pediatric physiatry: How social distancing can bring physicians and families closer together. J Pediatr Rehabil Med 2020; 13:329-338. [PMID: 33104050 DOI: 10.3233/prm-200747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The coronavirus (COVID-19) pandemic triggered wide scale implementation of telemedicine in the United States. The government response, Coronavirus Aid, Relief, and Economic Security (CARES) Act, permitted loosening of existing restrictions on telemedicine enabling its rapid incorporation into the delivery of medical care for children and adults. Prior to COVID-19, few pediatric physiatrists had opportunities to access high fidelity telemedicine platforms to provide health care for patients with special needs, mobility impairments, developmental delays, neuromuscular disorders or other complex medical conditions. This literature review will explore how telemedicine can optimize health care delivery options for pediatric physiatrists in various inpatient and outpatient settings such as consultations, acute inpatient units, outpatient clinics and long-term care facilities. Detailed analysis of the current research in telemedicine applications as well as a critical review of the limitations and barriers for its use offers a plethora of opportunities for enhancement of continuity and coordination of care. Telemedicine may decrease healthcare disparities and increase access of care for children with special needs. Additional research is needed to assess the efficacy of telemedicine when addressing complex medical conditions in children.
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Affiliation(s)
- Renat Sukhov
- Pediatric Rehabilitation Medicine, Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
| | - Afua Asante
- Pediatric Rehabilitation Medicine, Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
| | - Gavriil Ilizarov
- MCIT Clinical Informatics, Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
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