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Stackpole KMW, Kharofa RY, Tucker JM, Novick MB, Fals AM, Bernier AV, Tammi EM, Khoury PR, Siegel R, Paul S, Naramore SK, Moore JM. Telehealth Use in a National Pediatric Weight Management Sample During the COVID-19 Pandemic. Child Obes 2024; 20:309-320. [PMID: 37440173 DOI: 10.1089/chi.2023.0041] [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] [Indexed: 07/14/2023]
Abstract
Background: This study aimed to assess the implementation and access to telehealth-delivered pediatric weight management (PWM) during the initial phase of the COVID-19 pandemic at six US PWM programs (PWMP) using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Methods: The COVID-19 period (COVID) was defined in this retrospective, multisite study as the time when each site closed in-person care during 2020. The Pre-COVID period (Pre-COVID) was an equivalent time frame in 2019. Patients were stratified by visit completion status. Patient characteristics for COVID and Pre-COVID were compared to examine potential changes/disparities in access to care. Results: There were 3297 unique patients included across the six sites. On average, telehealth was initiated 4 days after in-person clinic closure. Compared with Pre-COVID, COVID (mean duration: 9 weeks) yielded fewer total completed visits (1300 vs. 2157) and decreased revenue (mean proportion of nonreimbursed visits 33.30% vs. 16.67%). Among the completed visits, COVID included a lower proportion of new visits and fewer patients who were male, non-English speaking, Hispanic, or Asian and more patients who were Black or lived ≥20 miles from the program site (p < 0.05 for all). Among no-show/canceled visits, COVID included more patients who had private insurance, older age, or a longer time since the last follow-up. Conclusion: Rapid implementation of telehealth during COVID facilitated continuity of PWM care. Clinic volume and reimbursement were lower during COVID and differences in the patient population reached by telehealth emerged. Further characterization of barriers to telehealth for PWM is needed.
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Affiliation(s)
- Kristin M W Stackpole
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Roohi Y Kharofa
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jared M Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Marsha B Novick
- Department of Pediatrics and Family and Community Medicine, Rush Medical College, Chicago, IL, USA
- Healthy Weight Program for Children and Teens, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Angela M Fals
- AdventHealth for Children/AdventHealth Medical Group Pediatric Weight and Wellness, Orlando, FL, USA
| | - Angelina V Bernier
- Metabolic & Obesity Program, Pediatric Endocrinology, UF Health Shands Hospital, Gainesville, FL, USA
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Erin M Tammi
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Philip R Khoury
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - Robert Siegel
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Suzanne Paul
- Department of Pediatrics, Section of Nutrition, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Sara K Naramore
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, IN, USA
- Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
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Cahan EM, Maturi J, Bailey P, Fernandes S, Addala A, Kibrom S, Krissberg JR, Smith SM, Shah S, Wang E, Saynina O, Wise PH, Chamberlain LJ. The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization. Acad Pediatr 2022; 22:1375-1383. [PMID: 35318159 PMCID: PMC8933868 DOI: 10.1016/j.acap.2022.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The COVID-19 pandemic prompted health systems to rapidly adopt telehealth for clinical care. We examined the impact of demography, subspecialty characteristics, and broadband availability on the utilization of telehealth in pediatric populations before and after the early period of the COVID-19 pandemic. METHODS Outpatients scheduled for subspecialty visits at sites affiliated with a single quaternary academic medical center between March-June 2019 and March-June 2020 were included. The contribution of demographic, socioeconomic, and broadband availability to visit completion and telehealth utilization were examined in multivariable regression analyses. RESULTS Among visits scheduled in 2020 compared to 2019, in-person visits fell from 23,318 to 11,209, while telehealth visits increased from 150 to 7,675. Visits among established patients fell by 15% and new patients by 36% (P < .0001). Multivariable analysis revealed that completed visits were reduced for Hispanic patients and those with reduced broadband; high income, private non-HMO insurance, and those requesting an interpreter were more likely to complete visits. Those with visits scheduled in 2020, established patients, those with reduced broadband, and patients older than 1 year were more likely to complete TH appointments. Cardiology, oncology, and pulmonology patients were less likely to complete scheduled TH appointments. CONCLUSIONS Following COVID-19 onset, outpatient pediatric subspecialty visits shifted rapidly to telehealth. However, the impact of this shift on social disparities in outpatient utilization was mixed with variation among subspecialties. A growing reliance on telehealth will necessitate insights from other healthcare settings serving populations of diverse social and technological character.
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Affiliation(s)
- Eli M. Cahan
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,New York University School of Medicine (EM Cahan), New York, NY,Address correspondence to Eli M. Cahan, MS, Department of Pediatrics, Stanford School of Medicine, 770 Welch Road, #100, Stanford, CA 94305
| | - Jay Maturi
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Paige Bailey
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Susan Fernandes
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Department of Medicine (S Fernandes), Stanford School of Medicine, Stanford, Calif
| | - Ananta Addala
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Sara Kibrom
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Jill R. Krissberg
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Stephanie M. Smith
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Sejal Shah
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Ewen Wang
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Department of Emergency Medicine (E Wang), Stanford School of Medicine, Stanford, Calif
| | - Olga Saynina
- Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Paul H. Wise
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Lisa J. Chamberlain
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
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Curfman AL, Hackell JM, Herendeen NE, Alexander JJ, Marcin JP, Moskowitz WB, Bodnar CEF, Simon HK, McSwain SD. Telehealth: Improving Access to and Quality of Pediatric Health Care. Pediatrics 2021; 148:peds.2021-053129. [PMID: 34462339 PMCID: PMC9633975 DOI: 10.1542/peds.2021-053129] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
All children and adolescents deserve access to quality health care regardless of their race/ethnicity, health conditions, financial resources, or geographic location. Despite improvements over the past decades, severe disparities in the availability and access to high-quality health care for children and adolescents continue to exist throughout the United States. Economic and racial factors, geographic maldistribution of primary care pediatricians, and limited availability of pediatric medical subspecialists and pediatric surgical specialists all contribute to inequitable access to pediatric care. Robust, comprehensive telehealth coverage is critical to improving pediatric access and quality of care and services, particularly for under-resourced populations.
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Affiliation(s)
| | - Jesse M. Hackell
- Department of Pediatrics, New York Medical College and Boston Children’s Health Physicians, Pomona, New York
| | - Neil E. Herendeen
- Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York
| | - Joshua J. Alexander
- Departments of Physical Medicine and Rehabilitation and Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - James P. Marcin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California Davis and University of California Davis Children’s Hospital, Sacramento, California
| | - William B. Moskowitz
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s of Mississippi and University of Mississippi Medical Center, Jackson, Mississippi
| | - Chelsea E. F. Bodnar
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Montana, Missoula, Montana
| | - Harold K. Simon
- Departments of Pediatrics and Emergency Medicine, School of Medicine, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - S. David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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