308 - Use of Telehealth During the COVID-19 Pandemic in US Pediatric Continuity Clinics

Poster Number: 308
Publication Number: 308.347

Maheen Quadri, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Hollyce Tyrrell, Academic Pediatric Association, McLean, VA, United States; Daniel Nicklas, University of Colorado School of Medicine, Greenwood Village, CO, United States; Amy J. Starmer, Boston Children's Hospital, Boston, MA, United States; Ada Fenick, Yale School of Medicine, New Haven, CT, United States

Background: In response to the COVID-19 pandemic, many offices incorporated telehealth into their healthcare delivery practices. It is unknown to what extent pediatric continuity clinic offices have utilized telehealth for clinical and educational purposes.

Objective: To describe the use of video technology in pediatric continuity clinic offices during the COVID-19 pandemic for 1) patient care, 2) precepting residents, and 3) teaching residents.

Design/Methods: Experts in pediatric primary care education constructed a survey containing demographics and questions about telehealth use. An invitation to participate was sent to all 117 Continuity Research Network (CORNET) pediatric residency programs, 45 of which agreed. The survey was distributed in March 2021. Bimonthly reminder emails were sent until survey closure in June 2021. Site characteristics and clinical practices related to telehealth were analyzed using summary statistics; responses to open-ended questions were analyzed qualitatively using thematic analysis.

Results: Of 45 participating programs, 35 (78%) completed the survey, representing 30% of CORNET. The majority were hospital affiliated offices (87%) in urban settings (86%) serving primarily non-white patients (86%) with public insurance (94%). A median of 10 precepting faculty (IQR 8 - 17) and 42 residents (IQR 26 - 60) worked at the the office, and a median of 75 patients (IQR 50 - 113) were seen at the office daily. Telehealth was used in the month prior to completion of the survey for an estimated 13% (SD = 26) of well child visits, 34% (SD = 24) of chronic care visits, and 35% (SD = 31) of acute care visits. The majority of precepting happened in-person, whether a patient was seen via telehealth (80%, SD = 33) or in-person (100%, SD = 0.85). Most programs have continued delivery of their primary care curriculum via synchronous in-person meetings (69%). Thematic analysis of decision-making regarding scheduling of visits, i.e., telehealth vs in-person, revealed the multifactorial nature of the process, accounting for patient, office, and clinical considerations (Figure 1). Respondents noted that changes brought on by the COVID-19 pandemic improved resident telehealth training and provided more opportunities for virtual and/or asynchronous learning.Conclusion(s): All participating CORNET programs reported telehealth use, with more use for chronic and acute care visits than for well child care. Most precepting and teaching continued to be synchronous and in-person. The expansion of telehealth during the COVID-19 pandemic has created new opportunities for resident training and virtual learning.
Figure 1Drivers of choice to see patient in-person vs via telehealth