164 - The Digital Divide in Pediatric Gastroenterology

Poster Number: 164
Publication Number: 164.411

Stephanie W. Hum, Children's Hospital Colorado, Denver, CO, United States; Zhaoxing Pan, University of Colorado School of Medicine, Aurora, CO, United States; Wenru Zhou, University of Colorado, Anschutz campus, Aurora, CO, United States; Cassandra Burger, Children's Hospital Colorado, Aurora, CO, United States; Pooja Mehta, Children's Hospital Colorado, Denver, CO, United States

Background: The utilization and reimbursement of technology-based health care services has drastically increased in the era of COVID-19. However, how patients may be impacted by this transition based on socioeconomic status, ethnicity, or primary language remains unknown.

Objective: To evaluate differences in the utilization of technology-based health care services based on demographic characteristics and the Area Deprivation Index (ADI) - a validated composite index of socioeconomic status.

Design/Methods: This retrospective cohort study included 2087 new patients seen in the Pediatric Gastroenterology Clinic at the Children’s Hospital Colorado for constipation from 1/1/2019-12/31/2020. Demographic variables, number of secure email messages (“MyChart messages”), telephone calls, and telehealth visits were extracted for up to one year. State and national ADI was assigned based on home address. Negative binomial regression model with ln follow-up time as an offset was used to evaluate for significance.

Results: The utilization of technology-based health care services (email messages and telehealth visits) increased from 2019 to 2020 (P < 0.001). The predicted mean number of patient-initiated email messages per year over the study period was significantly lower in those with lower socioeconomic status based on state ADI (incidence rate ratio (IRR)=0.97; P=0.03), non-English speakers (IRR=0.87; P < 0.001), Hispanic patients (IRR=0.69, P < 0.001), and those with government insurance (IRR=1.3; P < 0.001) (Figure 1). The predicted mean number of patient-initiated phone calls per year was significantly lower in those with lower socioeconomic status based on state ADIs (IRR=0.97; P=0.03) and non-English speakers (IRR=0.42; P=0.02) (Figure 2). The predicted mean number of telehealth visits per year did not differ based on ADI, but was significantly lower in non-English speakers (IRR=0.04, P < 0.001), Hispanic patients (IRR=0.56, P < 0.001), and those with government insurance (IRR=0.77, P=0.02) (Figure 3). Year initially seen (2019 versus 2020) significantly interacted with the relationship between telehealth visits and ADI (P=0.049 for state ADI and P=0.02 for national ADI).Conclusion(s): Patients with lower socioeconomic status, non-English speakers, and Hispanic patients less frequently utilize technology-based health care services and the COVID-19 pandemic has only exacerbated some of these disparities. Thus, while technology-based health care services may help to increase access to care for some patients, it is important to minimize barriers to prevent the worsening of already-existing inequities in health care access.
CV for Stephanie Hum, MDHum PAS Resume.pdf
Figure 2. Predicted mean number of patient-initiated telephone calls per year based on state ADI, spoken language, ethnicity, and insuranceFigure 2.jpeg