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Wallis KE, Kennelly A, Wozniak SN, Craig S, Flaherty CM, Cacia J, Christiansen A, Cordero L, Ortiz P, Kellom KS, Stefanski K. Disparities in Telehealth Uptake for Developmental-Behavioral Pediatric Assessments by Preferred Family Language: A Developmental Behavioral Pediatrics Research Network Study. J Dev Behav Pediatr 2024; 45:e378-e383. [PMID: 39259268 DOI: 10.1097/dbp.0000000000001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/22/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE Owing to the coronavirus disease 2019 (COVID-19) pandemic, many developmental-behavioral pediatric (DBP) practices adopted telehealth for care delivery. However, telehealth access and use for families with a preferred language other than English (PLOE) is an equity concern. Therefore, our study objective is to compare rates of telehealth utilization and visit completion by preferred family language among patients seen for DBP assessments during the COVID-19 pandemic. METHODS We completed a descriptive chart review using electronic health record data at 4 academic DBP practices to examine visits for patients up to 5 years seen for new-patient appointments between April 2020 and April 2021. We compared rates of in-person and telehealth visits by preferred family language and visit outcome (completed or missed). RESULTS A total of 3241 visits were scheduled between April 2020 and April 2021; 48.2% were for in-person and 51.8% for telehealth. Families reported the following languages: 90.5% English, 6.2% Spanish, and 3.3% other language. Missed visits accounted for 7.6% of scheduled visits. The relative percentage of in-person versus telehealth visits varied significantly by site (p < 0.001) and preferred family language (p < 0.001). English-speaking patients had 2.10 times the odds of being scheduled for telehealth compared with patients with PLOE, adjusting for site. Statistically significant differences were not found for visit outcome (completed or missed) by visit type (in-person or telehealth) (p = 0.79), including after accounting for PLOE status (p = 0.83). CONCLUSION At the height of the pandemic, most English-speaking families were scheduled for new DBP evaluations by telehealth, but fewer families with PLOE were. Attention to language to ensure telehealth access equity is critical.
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Affiliation(s)
- Kate E Wallis
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Annie Kennelly
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sarah N Wozniak
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sansanee Craig
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Carina M Flaherty
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jaclyn Cacia
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Audrey Christiansen
- Division of Developmental-Behavioral Pediatrics Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Lucero Cordero
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Priscilla Ortiz
- Language Services Department, Children's Hospital of Philadelphia, Philadelphia, PA; and
| | | | - Kristen Stefanski
- Division of Developmental and Behavioral Pediatrics, Akron Children's Hospital, Akron, OH
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Buck A, Hurewitz S, Franklin MS. Workforce perspective on racial and ethnic equity in early childhood autism evaluation and treatment: "The cornerstone of everything we do". AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241235522. [PMID: 38477296 DOI: 10.1177/13623613241235522] [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: 03/14/2024]
Abstract
LAY ABSTRACT Black and non-White Latinx children tend to receive autism diagnoses later in life and with a higher degree of impairment than White children. The purpose of this study was to learn what is currently helping as well as preventing Black and non-White Latinx children from getting access to autism evaluation and services. We held virtual interviews with 26 experts who work with autistic children and their families, including clinical providers, researchers, advocates, and policymakers/government representatives. From these interviews, we identified four themes that have an impact on equity in autism services: (1) who makes up the workforce, (2) workforce capacity and accessibility, (3) workforce payment structure, and (4) changes due to the COVID-19 pandemic. These findings show the need for improved workforce diversity, autism-specific education, payment structures, and additional support for workforce members to avoid burnout. To make childhood autism services more equitable, diversity in recruitment across training levels, cultural awareness, increased autism education for all pediatric providers, and partnerships with caregivers as experts must be prioritized. These investments in the autism workforce will allow professionals in the field to better meet the needs of children and families from Black and non-White Latinx communities and achieve equity in early childhood autism services.
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Kellom KS, Flaherty CM, Cacia J, Christiansen A, Cordero L, Hah J, Kennelly A, Ortiz P, Stefanski K, Wozniak SN, Wallis KE. Provider and Caregiver Perspectives on Telehealth Assessments for Autism Spectrum Disorder in Young Children: A Multimethod DBPNet Study Exploring Equity. J Dev Behav Pediatr 2023; Publish Ahead of Print:00004703-990000000-00111. [PMID: 37315107 DOI: 10.1097/dbp.0000000000001198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/18/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Telehealth uptake increased dramatically during the COVID-19 pandemic, including for autism spectrum disorder (ASD) assessment by developmental-behavioral pediatric (DBP) clinicians. However, little is known about the acceptability of telehealth or its impact on equity in DBP care. OBJECTIVE Engage providers and caregivers to glean their perspectives on the use of telehealth for ASD assessment in young children, exploring acceptability, benefits, concerns, and its potential role in ameliorating or exacerbating disparities in access to and quality of DBP care. METHODS This multimethod study used surveys and semistructured interviews to describe provider and family perspectives around the use of telehealth in DBP evaluation of children younger than 5 years with possible ASD between 3/2020 and 12/2021. Surveys were completed by 13 DBP clinicians and 22 caregivers. Semistructured interviews with 12 DBP clinicians and 14 caregivers were conducted, transcribed, coded, and analyzed thematically. RESULTS Acceptance of and satisfaction with telehealth for ASD assessments in DBP were high for clinicians and most caregivers. Pros and cons concerning assessment quality and access to care were noted. Providers raised concerns about equity of telehealth access, particularly for families with a preferred language other than English. CONCLUSION This study's results can inform the adoption of telehealth in DBP in an equitable manner beyond the pandemic. DBP providers and families desire the ability to choose telehealth care for different assessment components. Unique factors related to performing observational assessments of young children with developmental and behavioral concerns make telehealth particularly well-suited for DBP care.
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Affiliation(s)
| | - Carina M Flaherty
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jaclyn Cacia
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Audrey Christiansen
- Boston University School of Medicine, Boston, MA
- Division of Developmental-Behavioral Pediatrics Boston Medical Center, Boston MA
| | - Lucero Cordero
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julia Hah
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Annie Kennelly
- Division of Developmental and Behavioral Pediatrics, Akron Children's Hospital, Akron, OH
| | - Priscilla Ortiz
- Language Services Department, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristen Stefanski
- Division of Developmental and Behavioral Pediatrics, Akron Children's Hospital, Akron, OH
| | - Sarah N Wozniak
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kate E Wallis
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Roberts MD, Christiansen A, O'Hagan B, Jansen E, Augustyn M. Developmentally-Trained Primary Care Clinicians: A Pipeline to Improved Access? J Dev Behav Pediatr 2023; 44:e350-e357. [PMID: 37205730 DOI: 10.1097/dbp.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/09/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The purpose of this study is to decrease wait time and improve access to developmental-behavioral pediatric (DBP) evaluation in children 4 years of age and younger as part of a quality improvement (QI) initiative in an urban safety-net hospital. METHODS A primary care pediatrician received DBP minifellowship training 6 hours per week for 1 year to become a developmentally-trained primary care clinician (DT-PCC). DT-PCCs then conducted developmental evaluations that consisted of using a Childhood Autism Rating Scale and Brief Observation of Symptoms of Autism to evaluate children 4 years and younger referred within the practice. Baseline standard practice involved a 3-visit model: DBP advanced practice clinician (DBP-APC) intake visit, neurodevelopmental evaluation by a developmental-behavioral pediatrician (DBP), and feedback by a developmental-behavioral pediatrician. Two QI cycles were completed to streamline the referral and evaluation process. RESULTS Seventy patients with a mean age of 29.5 months were seen. The average days to initial developmental assessment decreased from 135.3 days to 67.9 days with a streamlined referral to the DT-PCC. Of the 43 patients who required further evaluation by a DBP, the average days to developmental assessment reduced from 290.1 to 120.4 days. CONCLUSION Developmentally-trained primary care clinicians allowed for earlier access to developmental evaluations. Further research should explore how DT-PCCs can improve access to care and treatment for children with developmental delays.
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Affiliation(s)
- Mona Doss Roberts
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Pediatrics, University School of Medicine, Boston Medical Center, Boston, MA
| | - Audrey Christiansen
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Pediatrics, University School of Medicine, Boston Medical Center, Boston, MA
| | - Belinda O'Hagan
- Boston Medical Center, Boston, MA
- Department of Pediatrics, University School of Medicine, Boston Medical Center, Boston, MA
| | - Emily Jansen
- Boston University School of Medicine, Boston, MA
- Department of Quality and Patient Safety, Boston, MA
| | - Marilyn Augustyn
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Pediatrics, University School of Medicine, Boston Medical Center, Boston, MA
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Zahid N, Ali A, Gul B, Danish SH, Israr SN, Anwar J. Perception and Attitude of Pakistani Doctors Toward the Use of Telemedicine Technology. Cureus 2022; 14:e31556. [DOI: 10.7759/cureus.31556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
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Jones E, Kurman J, Delia E, Crockett J, Peterson R, Thames J, Salorio C, Kalb L, Jacobson L, Stone J, Zabel TA. Parent Satisfaction With Outpatient Telemedicine Services During the COVID-19 Pandemic: A Repeated Cross-Sectional Study. Front Pediatr 2022; 10:908337. [PMID: 36090558 PMCID: PMC9453196 DOI: 10.3389/fped.2022.908337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Prior to the COVID-19 pandemic, the development of hospital-based telemedicine services had been slow and circumscribed in scope due to insurance and licensure restrictions. As these restrictions were eased during the COVID-19 pandemic to facilitate ongoing patient care, the public health emergency facilitated a rapid expansion and utilization of telemedicine services across the ambulatory service sector. Objectives The current quality improvement (QI) study utilized this unprecedented opportunity to evaluate the use of telemedicine services across a variety of clinical disciplines and patient groups. Methods Caregivers of patients (ages 0-21) who received care through an outpatient specialty center provided experience ratings of telemedicine services delivered during the initial pandemic months (March-June 2020; N = 1311) or during the national "winter surge" in late 2020 (November 2020-February 2021; N = 1395). Questionnaires were distributed electronically following the clinical visits, and ANCOVA was employed (with patient age as the covariate) to determine if caregiver responses differed based on patient demographic characteristics. Results Ratings of patient satisfaction with services were very strong at both time points; greater variability in scores was noted when caregivers were asked if they would use telemedicine services again. At both time points, younger patient age (i.e., age 0-5) was associated with decreased caregiver willingness to use telemedicine services in the future. Smaller effects were seen for certain "hands on" therapies (occupational, physical, and speech) during the initial months of the pandemic and for proximity to the hospital during the "winter surge." Conclusions These data suggest a very positive overall caregiver response to telemedicine-based services during the COVID-19 pandemic. Several areas of potential improvement/innovation were identified, including the delivery of telemedicine therapies (e.g., occupational, physical, and speech) services to young patients (i.e., aged 0-5).
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Affiliation(s)
- Erin Jones
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Jaime Kurman
- Office of Patient Experience and Community Engagement, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Elisa Delia
- Administration, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Jennifer Crockett
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States.,Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jasmin Thames
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Cynthia Salorio
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Luther Kalb
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Lisa Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jacqueline Stone
- Administration, Kennedy Krieger Institute, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - T Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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