Pediatric, Urgent Care Telemedicine During COVID-19: A Comparative Analysis.

Background: Telemedicine holds potential for improving access to care, but to what extent has it been realized? We examined telemedicine utilization within a pediatric health care system into the second year of the COVID-19 pandemic to illuminate maintenance of changes in patient diversity previously observed and to elucidate ongoing opportunities to support health equity. Materials and Methods: This IRB-approved study is a retrospective analysis of completed visits for parent-initiated, urgent care telemedicine services received by a pediatric health care system between June 2020 and July 2021. Unique patient characteristics were compared with those from 2019 (baseline) and early pandemic. Results: Current study patients (n = 9,064) did not differ from patients in either prior time point (n = 5,462) in race, ethnicity, age, or sex (ps > 0.05). Thirteen preferred languages spoken, relative to 5 at the 2019 baseline. Telemedicine was utilized significantly more than baseline among patients accessing government-subsidized health insurance (p < 0.05); utilization among rural patients (1.2%) declined relative to baseline (p < 0.05). Discussion: This research examined demographic changes among patients utilizing urgent care telemedicine throughout the COVID-19 pandemic and illuminated the importance of sustaining the virtual care needs of a more diverse patient population. Conclusion: Unlocking telemedicine's potential has implications for improving health equity. Our research demonstrates that patients seeking virtual care in the "new normal" represent a greater demographic diversity than observed prepandemic. Mitigation strategies used during the pandemic to engage and support a diverse patient population, including regulatory waivers, technological outreach, and translation services, must continue in support of equitable access for all.

Patient and Visit Characteristics of Families Accessing Pediatric Urgent Care Telemedicine During the COVID-19 Pandemic.

Introduction: Telemedicine expansion during the coronavirus pandemic improved health care access for some. However, studies show disparate uptake among marginalized communities, where minority patients experience higher infection rates. We examined changes in pediatric telemedicine utilization as related to social determinants of health and characteristics of families accessing care. Materials and Methods: This IRB-approved study is a retrospective, cross-sectional comparison of completed visits for parent-initiated, urgent care telemedicine services received by a pediatric health care system between January to May 2019 and January to May 2020. Patient and visit characteristics were evaluated by region (Florida or Delaware Valley) and year for age, race, gender, ethnicity, zip code, language, median household income, insurance type, and patient draw. Results: Outcomes varied by region. Pediatric patient visits jumped by 172% in 2020 from the year prior. In Florida, the proportion of Hispanic patients utilizing telemedicine increased, as did patients utilizing government-supported health insurance during the pandemic (ps < 0.05). Practically meaningful, although nonsignificant increases in patient language diversity were found across years in both regions (ps > 0.05). Rural patient utilization remained low (2-5%; ps > 0.05). Discussion: Changes in telemedicine use were observed among pediatric patients in vulnerable populations during the coronavirus disease 2019 (COVID-19) pandemic. Despite increased utilization among Hispanic and low-income families, access to virtual care remains a challenge among patients residing in rural locales. Conclusion: Researchers, health care providers, and policymakers should examine the implementation of varying mitigation strategies that support equal access and use of virtual health care among an increasingly diverse, post-COVID-19 pediatric patient population.

On-Demand, Virtual Health Care During COVID-19: Clinician Redeployment and Telemedicine Utilization in a Children's Health System.

Background: The COVID-19 global pandemic inspired an unprecedented surge in virtual health care. Safety precautions limited in-person urgent care options, despite high patient demand. This study describes how one children's health system redeployed clinical health professionals to expand existing pediatric, urgent care, on-demand telemedicine in the early months of the United States' pandemic response. Patient utilization and visit characteristics during the pandemic are contextualized relative to pre-pandemic, business-as-usual (BAU) operations. Materials and Methods: This IRB-approved study is a descriptive, retrospective analysis. Key elements of the clinician redeployment process and shift in physician workflow are described. Retrospective data analysis included routine patient and visit characteristics for urgent care, on-demand telemedicine services received January to May 2020. BAU represented telemedicine encounters between January and May 2019. Results: Twenty-eight redeployed pediatricians and advanced practice registered nurses were trained and credentialed to assist the on-demand pediatrician team on the existing telemedicine platform. During 2020, providers completed 5,055 telemedicine visits, a 168% increase over the same timeframe in 2019. Pre-pandemic visit wait time was 6.29 ± 5.4 min, which increased to 23.25 ± 34.30 min during 2020. Top chief complaints included skin-related concerns (27.9%) and upper respiratory infections (20.2%) and were consistent across years. Patient satisfaction with provider and platform were high. Discussion: By engaging and training redeployed clinicians during the pandemic response, health care access was maintained for thousands of patients. Conclusion: Where regulations allow, clinical health professionals can be trained and redeployed rapidly to on-demand telemedicine platforms to successfully meet spontaneous increases in demand for virtual care.

A Pediatric Telemedicine Response to a Natural Disaster.

Background: Hurricane Irma, a catastrophic Category 4 storm, made landfall in Florida on September 10, 2017. Nemours CareConnect (NCC) offered direct-to-consumer (DTC) pediatric telemedicine during Hurricane Irma. Introduction: Although other programs have examined disaster response and postdisaster recovery by using telemedicine, no studies report use of a pediatric-specific, DTC platform during all three phases of disaster management. Materials and Methods: This IRB-approved study is a retrospective analysis of NCC's audio-visual telemedicine encounters performed on September 8-16, 2017. Results: From September 8 to 16, 2017, NCC recorded 262 completed telemedicine visits. The mean wait time was 12.23 ± 14.4 min. The mean length of the telemedicine encounter was 10.12 ± 4.42 min. Most telemedicine visits occurred on the day before the storm (27.9%), followed by the day after the storm (19.5%). Most common chief complaints were upper respiratory symptoms (33.6%), skin-related concerns (19.1%), fever (16.8%), and gastrointestinal concerns (6.5%). Patient satisfaction remained high during the storm, for the provider as well as the platform. Discussion: During Hurricane Irma, NCC offered accessible and efficient care to families who were impacted by the storm throughout Florida. Results suggest a differential pattern of use before the storm's arrival, during, and immediately after the storm, which may be informative to other telemedicine providers. Conclusion: Further research is needed on the integration of telemedicine into the disaster preparedness plans at a local, state, and national level to ensure maximum support for those families in need.

A digital health application for managing pediatric asthma: Use and benefits.

Childhood asthma is a common and serious chronic lung disease. Mobile health (mHealth) technologies may assist clinical providers, caregivers, and children in managing pediatric asthma. This study evaluated the Nemours app, an mHealth application. We examined: a) frequency of data access by providers and feature use by caregivers (parents/legal guardians) of 5-11-year-old children diagnosed with asthma and b) whether utilization was related to benefits. Nine providers (allergists/pulmonologists) and 80 patient-families (caregiver/child dyads) participated. Two-years of retrospective data were obtained for asthma control, in-person urgent healthcare utilization, and app utilization. Six-months of prospective data included asthma control, in-person urgent healthcare utilization, app utilization, surveys, and health literacy screeners. Providers (56%) accessed app data and caregivers (61%) utilized the app. Caregiver use of messaging feature predicted gains in health literacy scores (b = .44, p = .041), suggesting app use may offer some educational benefits. Implementation of strategies that support app engagement and utilization may help to maximize intended benefits.

Small-Group, Emergent Literacy Intervention Under Two Implementation Models: Intent-to-Treat and Dosage Effects for Preschoolers at Risk for Reading Difficulties.

Preschool-age children identified as at risk for later reading difficulties can benefit from supplemental, small-group emergent literacy intervention. As such interventions become commercially available and marketed to preschool programs, it is important to understand their impacts when implemented by intended end users under routine conditions. In this study, we examined the effects of the Nemours BrightStart! (NBS!) intervention on children's emergent literacy skills when implemented by teachers and community aides in authentic preschool classrooms. We randomly assigned 98 classrooms to one of three conditions (NBS! teacher-implemented, NBS! community aide-implemented, or control). Children enrolled in these classrooms who met eligibility criteria and were identified as at risk via an early literacy screener (n = 281) completed pretest and posttest emergent literacy assessments; those assigned to NBS! conditions received intervention from their classroom teacher or a community aide affiliated with a local kindergarten-readiness initiative. Intent-to-treat analyses showed no significant impacts of NBS! on any outcome, and an instrumental variable, as-treated approach showed one significant intervention effect on letter writing. Consequently, we did not replicate results of prior highly controlled efficacy trials. Findings have implications for revising the NBS! theory of change, conducting dosage and as-treated analyses, and moving research-based interventions toward scale-up.

How Telehealth Stopped A Contagious Outbreak At A School.

A school-based telehealth program helps identify a disease outbreak before it gets out of hand.