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EP-123 - Impact of a Pediatric Outpatient Tele-Neurology Program on Patients’ Access to Care and Hospital Utilization

Tuesday, May 1
12:15 PM - 12:30 PM
Location: Education Zone, Booth 2416, Screen 2

Background: The shortage of neurologists relative to patients' demand for services stands at 10% for adults and 20% for children, and is projected to grow or persist over the next decade (1). In rural and medically underserved areas, this general shortage is exacerbated by the clustering of subspecialists in urban areas. Hardships associated with long travel distances such as missed work and transportation costs may put parents at risk of missing their child's scheduled appointment. Missing routine visits leads to inconsistent management of care, which can result in unplanned visits to urgent care, emergency department (ED), or hospital admission (2-3). Telemedicine has the potential to improve access to pediatric neurologists. The Pediatric Telemedicine Program at University of California Davis (UCD) Health has provided more than 5,500 subspecialist consultations through telemedicine to children in underserved regions since 1996. The pediatric neurology telemedicine program is one of oldest telemedicine programs for children at UCD Health. The objective of this study was to characterize the patient population served by this program and to evaluate its impact on patient outcomes.

Methods: We conducted analyses of a convenience sample of patients which included children (≤18 years old) who obtained a pediatric neurology consultation between 1/1/2009 and 12/31/2016. We compared demographic and diagnostic data of children receiving consultations in-person (at UCD Health) and children receiving consultations over telemedicine.

Results: During the study period, there were 797 tele-neurology consultations on 357 children and 9,230 in-person consultations on 3,250 children. The mean age at first encounter with UCD Health was 8.1 (SD 5.4) years for children who obtained telemedicine consultations and 7.7 (SD 4.6) years for children who obtained in-person consultations (p>0.05). 44.7% of children in the telemedicine group and 45.1% children in the in-person group were female (p>0.05). 95% of the telemedicine consultations were reimbursed through Medicaid or the university's telemedicine contracts and grants, while 5% were reimbursed by commercial insurance. In contrast, 53% of the in-person consultations were reimbursed by commercial insurance while 47% were reimbursed by Medicaid (p<0.001). The primary diagnoses of the telemedicine consultations included convulsions (17.7%), epilepsy (15.0%), head and neck symptoms (5.0%) and developmental delays (4.8%). In comparison, the primary diagnoses for the in-person consultations included epilepsy (13.9%), behavioral disorders (9.7%), developmental delays (6.3%) and convulsions (3.9%). 14.3% of children in the telemedicine group had one or more chronic conditions compared to 30% of children in the in-person group (p<0.001). The mean encounter length of telemedicine consultations was 43.5 (SD 14.3) minutes and that of in-person consultations was 38.4 (SD 15.2) minutes (p<0.001).

Conclusions: In this study we found that children who obtained telemedicine consultations and children who obtained in-person consultations are comparable with respect to demographics such as age and gender, but have different clinical characteristics and required slightly longer visit times. In future analyses, we will evaluate the association between the use of telemedicine and no-show rates of patients' scheduled appointments. We will also evaluate the association of telemedicine use with all - cause and neurology specific - hospital encounters among children.

Learning Objectives:

Parul Dayal

PhD candidate
University of California Davis

Parul Dayal is a PhD candidate in Epidemiology and works with the Department of Pediatrics at the University of California in Davis under Dr. James Marcin. Her research focuses on evaluating the disparities in access and quality of subspecialty care among children. Her research interests also include evaluating the clinical and financial outcomes associated with telemedicine for improving access to high-quality care for children in rural and underserved areas. Parul has authored manuscripts on the impact of telemedicine and the presence of disparities in healthcare among children in journals such as Pediatrics, Pediatric Critical Care Medicine, Annals of Emergency Medicine and Pediatric Emergency Care.

Presentation(s):

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