Association of Race and Socioeconomic Disadvantage With Missed Telemedicine Visits for Pediatric Patients During the COVID-19 Pandemic

Brociner, Evan; Yu, Kun‐Hsing; Kohane, Isaac S.; Crowley, McGreggor

doi:10.1001/jamapediatrics.2022.1510

Cited by 12 publications

(12 citation statements)

References 5 publications

(10 reference statements)

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“…Despite the improved overall no-show rates, one recent pediatric gastroenterology study during the COVID-19 pandemic showed that patients classified as lower socioeconomic status had a 4 × higher odds of no-show visits compared to higher socioeconomic status patients. Additionally, patients with a higher probability of economic disadvantage were associated with a 5 × increased odds of no-show for telemedicine visits compared to in-person visits [ 14 ]. Thus, it will be important moving forward in pediatric subspecialties to help facilitate telemedicine or in-person clinic visits (easier scheduling, etc.)…”

Section: Discussionmentioning

confidence: 99%

“…As previously reported, to determine neighborhood-specific socioeconomic status, ArcGIS Pro (Esri, Redlands, California) was used to geocode patients’ addresses at diagnosis into their corresponding census tracts, and then calculated the ADI score for each census tract [ 11 Oluyomi]. The ADI is a composite measure of neighborhood deprivation developed and validated by Singh, which relies on 17 weighted indicators drawn from four categories of the US Census American Community Survey (ACS) 5-year estimates: poverty, housing, employment, and education (Supplementary Table 1) [ 12 – 14 ]. Census tracts were then divided into high vs low ADI score distribution.…”

Section: Methodsmentioning

confidence: 99%

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Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era

et al. 2022

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The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. We performed a retrospective chart review of Texas Children’s Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use ( p < 0.05). We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients ( n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10–17 yo) was associated with increased telemedicine (OR 2.04, 95%CI 1.71, 2.43) and patient portal use (OR 1.70, 95%CI 1.33, 2.17). Public insurance (OR 1.66, 95%CI 1.25, 2.20) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities. Supplementary Information The online version contains supplementary material available at 10.1007/s00246-022-03042-4.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Despite the improved overall no-show rates, one recent pediatric gastroenterology study during the COVID-19 pandemic showed that patients classi ed as lower socioeconomic status had a 4x higher odds of no-show visits compared to higher socioeconomic status patients. Additionally, patients with a higher probability of economic disadvantage were associated with a 5x increased odds of no-show for telemedicine visits compared to in-person visits [11]. Thus it will be important moving forward in pediatric subspecialties to help facilitate telemedicine or in-person clinic visits (easier scheduling, etc.)…”

Section: Discussionmentioning

confidence: 99%

Remote Care Adoption in Underserved Congenital Heart Disease Patients during the COVID-19 Era

Morrison

Moore

Moreno

et al. 2022

Preprint

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Objective The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. Methods We performed a retrospective chart review of Texas Children’s Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use (p < 0.05). Results We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients (n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10–17 yo) was associated with increased telemedicine (OR 2.05, 95%CI 1.73, 2.45) and patient portal use (OR 1.70, 95%CI 1.33, 2.18). Public insurance (OR 1.73, 95%CI 1.31, 2.29) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Conclusion Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities.

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“…5,6 Populations already at risk for health care disparities have been found to be more prone to missed care opportunities with a greater reliance on audio-only telephone-based visits. [7][8][9] Phone encounters may be more feasible in some settings, but lack the same level of providerpatient engagement and monitoring afforded by video modalities. 10 Altogether, internet connectivity has become increasingly recognized as a social determinant of health.…”

Section: Background and Significancementioning

confidence: 99%

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities

et al. 2023

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Objective: The COVID-19 pandemic accelerated the adoption of telehealth technologies. Persistent disparities in telecommunication devices, internet connectivity, and digital literacy, however, undermine the potential for telemedicine to reduce barriers to healthcare access. Health systems may have a role in addressing these structural inequities. We describe the operationalization and feasibility of an internet-enabled tablet loaner program at a freestanding children’s hospital. Methods: Between October 2020-October 2021, pediatricians enrolled families through ambulatory clinics at an academic urban freestanding children’s hospital. Eligibility criteria included difficulty accessing virtual care due to lack of stable internet or device. Tablets featured an unlimited data package, access to the patient portal, and virtual visit platform. A private technology company managed device configuration and distribution. To characterize program impact, we compared the proportion of completed clinical encounters during the intervention compared with a pre-intervention period (March 2020-October 2020) and conducted a qualitative survey with program participants. Participant and visit characteristics were obtained from the electronic medical record and summarized with descriptive statistics. Results: A total of 111 families participated in the tablet loaner program, the majority of whom were Hispanic (51.4%) and Black, non-Hispanic (21.6%) and publicly insured (64.9%). Between the pre-intervention and intervention period, there was a significant increase in completed video- and phone-based virtual visits (75.3% vs. 79.1%, p=0.038). The proportion of video-based only visits increased from 82.9% to 88.9 %. p < 0.001). Families reported that the tablet improved the patient’s ability to receive medical care (93.7%) and was easy to use (93.9%). Conclusion: The tablet loaner initiative was associated with an improvement in markers of virtual visit engagement and healthcare experience. Efforts to expand telemedicine equity must consider technological access and digital literacy as well as broad coalitions across industry, government, and community organizations.

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Association of Race and Socioeconomic Disadvantage With Missed Telemedicine Visits for Pediatric Patients During the COVID-19 Pandemic

Cited by 12 publications

References 5 publications

Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era

Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era

Remote Care Adoption in Underserved Congenital Heart Disease Patients during the COVID-19 Era

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities

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