Telehealth: Improving Access to and Quality of Pediatric Health Care

Curfman, Alison; Hackell, Jesse M.; Herendeen, Neil E.; Alexander, Joshua; Marcin, James P.; Moskowitz, William B.; Bodnar, Chelsea E. F.; Simon, Harold K.; McSwain, S. David

doi:10.1542/peds.2021-053129

Cited by 70 publications

(43 citation statements)

References 17 publications

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“…Recently, the American Academy of Pediatrics (AAP) Section on Telehealth Care, Committee on Practice and Ambulatory Medicine, and Committee on Pediatric Workforce advocated for telehealth as a means of decreasing disparities in access to care by extending paediatric expertise and best practices to children and adolescents no matter where they are located. 12 This is limited, however, by our capacity to address barriers associated with language, digital literacy, special needs, and access to and payment for technology infrastructure. In addition, the AAP argue for payment for telehealth services at parity with the equivalent services provided in-person by private and public insurers.…”

Section: Discussionmentioning

confidence: 99%

Telehealth services for cardiac neurodevelopmental care during the COVID-19 pandemic: a site survey from the Cardiac Neurodevelopmental Outcome Collaborative

et al. 2022

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Objective: COVID-19 has markedly impacted the provision of neurodevelopmental care. In response, the Cardiac Neurodevelopmental Outcome Collaborative (CNOC) established a Task Force to assess the telehealth practices of cardiac neurodevelopmental programs during COVID-19, including adaptation of services, test protocols and interventions, and perceived obstacles, disparities, successes, and training needs. Study Design: A 47-item online survey was sent to 42 CNOC member sites across North America within a 3-week timeframe (22 July to 11 August 2020) to collect cross-sectional data on practices. Results: Of the 30 participating sites (71.4% response rate), all were providing at least some clinical services at the time of the survey and 24 sites (80%) reported using telehealth. All but one of these sites were offering new telehealth services in response to COVID-19, with the most striking change being the capacity to offer new intervention services for children and their caregivers. Only a third of sites were able to carry out standardized, performance-based, neurodevelopmental testing with children and adolescents using telehealth, and none had completed comparable testing with infants and toddlers. Barriers associated with language, child ability, and access to technology were identified as contributing to disparities in telehealth access. Conclusions: Telehealth has enabled continuation of at least some cardiac neurodevelopmental services during COVID-19, despite the challenges experienced by providers, children, families, and health systems. CNOC provides a unique platform for sharing challenges and successes across sites, as we continue to shape an evidence-based, efficient, and consistent approach to the care of individuals with CHD.

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Section: Discussionmentioning

confidence: 99%

Telehealth services for cardiac neurodevelopmental care during the COVID-19 pandemic: a site survey from the Cardiac Neurodevelopmental Outcome Collaborative

et al. 2022

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“…Even before the COVID-19 pandemic, digital barriers were known to exist in the United States for diverse populations, non-English speakers, and those with low SES 19. In their policy statement on telehealth, the American Academy of Pediatrics (AAP) notes that lack of high-speed Internet access and other technological resources impedes the delivery of telehealth and increases inequity in access to care 20. To address this divide, the AAP recommends interventions such as using telehealth software that supports smartphone use and integrated language interpretation 21…”

Section: Discussionmentioning

confidence: 99%

“…19 In their policy statement on telehealth, the American Academy of Pediatrics (AAP) notes that lack of highspeed Internet access and other technological resources impedes the delivery of telehealth and increases inequity in access to care. 20 To address this divide, the AAP recommends interventions such as using telehealth software that supports smartphone use and integrated language interpretation. 21 This study demonstrated that, while telemedicine has overall reduced MCOs in pediatric subspecialty care, these increases in access were not equitably distributed.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic Missed-care Predictors for Pediatric Orthopaedic Telemedicine During COVID-19

Tartarilla¹,

Tennermann²,

Melvin³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Increased telehealth services may not benefit communities already lacking access to care. Race, socioeconomic status, and insurance type are known to predict missed-care opportunities (MCO) in health care. We examined differences in pediatric orthopaedic telemedicine MCOs during the COVID-19 pandemic, compared with MCOs of in-person visits in a prepandemic time frame. We hypothesized that groups with known health disparities would experience higher rates of pediatric orthopedic telemedicine MCOs. Methods: We retrospectively analyzed pediatric orthopaedic telemedicine MCOs during the COVID-19 pandemic lockdown (March-May 2020) and in-person pediatric orthopaedic visit MCOs during a nonpandemic timeframe (March-May 2019). We examined predictors of MCOs including race, ethnicity, language, insurance status, and other socioeconomic determinants of health. Results: There were 1448 telemedicine appointments in the pandemic cohort and 8053 in-person appointments in the prepandemic cohort. Rates of telemedicine MCOs (12.5%; n=181) were significantly lower than in-person MCOs (19.5%; n=1566; P<0.001). Telemedicine appointments with public insurance or without insurance (P<0.001) and being Black or Hispanic/Latinx (P=0.003) were associated with MCOs. There were significant differences between in-person MCOs and telemedicine MCOs among all predictors studied, except for orthopaedic subspecialty team and patient’s social vulnerability index. Conclusions: Patients with telemedicine appointments during the COVID-19 pandemic were less likely to experience MCOs than patients with in-person visits during the nonpandemic timeframe. However, when controlling for socioeconomic factors including race, ethnicity, and insurance type, disparities found for in-person visits persisted with the shift to telemedicine. Pediatric orthopaedists should be aware that the use of telemedicine does not necessarily improve access for our most vulnerable patients. Level of Evidence: Level III.

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“…Recently, the American Academy of Pediatrics emphasized the growing importance of telehealth services and the need to monitor telehealth's impact on social patterns of healthcare utilization 3 . The early phase of the pandemic was associated with reduced in-person pediatric visits 4 .…”

Section: Introductionmentioning

confidence: 99%

The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization

Cahan¹,

Maturi²,

Bailey³

et al. 2022

Academic Pediatrics

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Telehealth: Improving Access to and Quality of Pediatric Health Care

Cited by 70 publications

References 17 publications

Telehealth services for cardiac neurodevelopmental care during the COVID-19 pandemic: a site survey from the Cardiac Neurodevelopmental Outcome Collaborative

Telehealth services for cardiac neurodevelopmental care during the COVID-19 pandemic: a site survey from the Cardiac Neurodevelopmental Outcome Collaborative

Sociodemographic Missed-care Predictors for Pediatric Orthopaedic Telemedicine During COVID-19

The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization

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