186 - Utilization of telehealth in high-risk infant follow up (HRIF) during the first months of the COVID pandemic in California

Poster Number: 186
Publication Number: 186.234

Susan R. Hintz, Stanford University School of Medicine, Palo Alto, CA, United States; Tianyao Lu, Stanford University School of Medicine, Alamo, CA, United States; Erika Gray, Stanford University School of Medicine, Stanford, CA, United States; Maria A. Jocson, California Department of Health Care Services, Sacramento, CA, United States

Background: The COVID pandemic has required rapid adaptations to healthcare delivery. High risk infant follow-up (HRIF) has traditionally been provided by in-person visits, but pandemic has required expanded approaches including telehealth. Telehealth uptake and factors associated with utilization across a statewide HRIF system in the first months of COVID have not been described.

Objective: In the California statewide HRIF network, we explored clinic and regional differences in telehealth deployment and characterized sociodemographic and program-level disparities associated with HRIF visit by telehealth during the first 10 months of the COVID pandemic

Design/Methods: The California Perinatal Quality Care Collaborative (CPQCC) is a population-based group of 140+ NICUs that partners with California Children's Services (CCS) to lead an integrated, statewide system of 66 HRIF clinics. Eligible infants are referred at NICU discharge for HRIF visits through 3 years. Queries were added to HRIF data collection in March 2020 to ascertain whether the visit was in person or by telehealth. We evaluated HRIF visits completed 4/1/2020 to 1/31/2021 to explore HRIF clinic and regional telehealth uptake and used multivariable logistic regression to examine factors associated with receiving a telehealth visit.

Results: Of 10,188 HRIF visits during the study period, 4274 (41.9%) were by telehealth. HRIF clinics varied broadly in use of any telehealth (17 reported no telehealth visits), and in % of telehealth visits among all visits ( < 1%-100%) [Fig 1]. There were substantial regional variations in % patients expected with any visit and % of HRIF visits done by telehealth [Fig 2]; for California overall, the % of visits that were telehealth peaked at 85.5% in 4/2020, reached a nadir (28.5%) in 11/2020, and increased (44.7%) by 1/2021. Multivariable regression [Tab 1] demonstrated factors associated with lower odds of having a telehealth visit included lower GA, maternal Hispanic race, and lower HRIF clinic volume, whereas factors associated with higher odds included Asian and Black maternal race, caregiver education less than high school, part time employment, and greater distance from clinic.Conclusion(s): This California population-based analysis of telehealth for HRIF during the first months of the COVID pandemic demonstrated heterogeneity in telehealth use.  Sociodemographic and program factors were independently associated with receiving a telehealth visit. Findings may be reflective of early challenges in launching telehealth; CPQCC-CCS HRIF has developed telehealth guidance and expanded telehealth-validated instrument options.
Figure 1. Proportion of patients expected with at least one visit of any type (blue) and proportion of all visits done by telehealth (orange) by HRIF site siteFigure 1.jpeg
Figure 2. Proportion of all HRIF visits in California regions* done by telehealth by monthFigure 2.jpeg