536 - Effect of Telehealth versus In-Person visits on Access to Neurology Outpatient Clinical Services for Children

Poster Number: 536
Publication Number: 536.139

Savithri Nageswaran, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Annette E. Grefe, Wake Forest Baptist Health - Brenner Children's Hospital, Winston-Salem, NC, United States; Shyh-Huei Chen, Department of Biostatisticd and Data Science, Winston-Salem, NC, United States; Eric Kirkendall, Wake Forest Baptist Health - Brenner Children's Hospital, Winston-Salem, NC, United States; Edward H. Ip, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States

Background: Access to specialty care for children with special healthcare needs is important for their well-being. Because of the COVID pandemic, health insurance companies allowed reimbursement for telehealth services in North Carolina (NC).

Objective: To evaluate the effects of telehealth versus in-person outpatient clinic visits on access to neurology services for children.

Design/Methods: Using Electronic Health Record data, information about children with appointments scheduled with pediatric outpatient neurology providers in a tertiary care children’s hospital was collected. Inclusion criteria were: age < 18 years, NC residence, and at least one pediatric neurology appointment between 3/10/19 and 3/9/21. Appointment outcomes (completion, cancelation, and no-show rates) were calculated for children who had at least one scheduled neurology scheduled in the Pre-Pandemic (3/10/19 to 3/9/20) and Pandemic (3/10/20 to 3/9/21) periods.  There were no telehealth visits in the Pre-Pandemic period. "Teleuser" was defined as a child who had at least one telehealth appointment scheduled. We used paired t-tests to compare visit rates in the two periods; and t-tests to compare teleuser and non-teleuser groups.

Results: A total of 2,102 children (teleuser: 1,254; non-teleuser: 848) had at least one scheduled neurology appointment in both the Pre-Pandemic and Pandemic periods. Teleuser compared with non-teleuser were more likely to be White, non-Hispanic, have private insurance, and live farther from the children’s hospital (Table 1).  Of the 11,115 neurology visits for these children, completion rates were as follows: Pre-Pandemic (in-person) 59%; Pandemic (in-person) 38%; and Pandemic (telehealth) 75%. For both teleuser and non-teleuser groups, there was a statistically significant decrease in completion rate, and increase in cancelation and no-show rates in the Pandemic period compared to the Pre-Pandemic period (Table 2). In the Pre-Pandemic period, there was no statistically significant difference between the teleuser and non-teleuser groups in completion and cancelation rates (Table 3). In the Pandemic period, there was a statistically significant increase in completion rate, and decrease in cancelation and no-show rates in the teleuser group compared to the non-teleuser group (Table 3). Conclusion(s): Visit rates to pediatric neurology outpatient clinic decreased substantially during the pandemic. Telehealth could mitigate the problems with access to pediatric neurology services. Children belonging to minority race/ethnicity are less likely use telehealth, further increasing their risk of poor access to specialty care.
Table 1. Demographic characteristics of children
Table 2. Pediatric neurology appointment outcomes in the Pre-Pandemic and Pandemic periods