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Evaluating Best Practices for Telemedicine in Pediatric Primary Care
During the COVID-19 pandemic, telemedicine use exploded. In the summer of 2021, 80% of pediatricians reported using telemedicine, compared with 16% just four years prior. However, there is little evidence to determine best practices for telemedicine in pediatric primary care. With grant support from the National Institutes of Health, researchers from Children"s Hospital of Philadelphia in partnership with Children"s Hospital of Pittsburgh, the American Academy of Pediatrics Pediatric Research in Office Settings (PROS) network, and University of Utah will study the best ways to integrate telemedicine into primary care to ensure positive patient outcomes.
"There are huge gaps in our understanding of what is really working and in what settings," said Alexander Fiks, MD, MSCE, director of Clinical Futures, a CHOP Research Institute Center of Emphasis. "Once we know how much of a difference telemedicine makes in different settings, and what the potential pitfalls are, we can advocate for policy supporting telemedicine payment, implement more support for telemedicine in practice, and develop clinical practice guidelines for how and when telemedicine should be used."
In-person Visits vs. Telemedicine Visits
In-person visits and telemedicine visits both have benefits. A child who requires regular followup could benefit more from telemedicine visits, which requires less time away from school. An in-person visit could be better in other instances, for example to provide vaccinations. The goal of the new study, Telemedicine Integrated into Pediatric Primary Care & Child Outcomes (TIPP-C), is to determine the best scenarios for telemedicine visits by comparing the quality of in-person and telemedicine visits across preventive care, chronic care, and acute care.
The study sites range from large health systems to independent practices, and federally qualified health centers across the country. In addition, the study includes both family medicine practitioners and pediatricians. The research team, co-led by Kristin Ray, MD, MS at the University of Pittsburgh will use electronic health record data from more than 1,000 sites to evaluate the differences in telemedicine outcomes.
The first aim of the study is to determine how telemedicine visits compare with in-person visits in terms of quality of care at the preventive care level (immunization visits), acute care level (visits for acute respiratory tract infection), and chronic care level (visits for asthma or attention-deficit hyperactivity disorder). The researchers also will examine the effect of telemedicine on health equity. The second aim of the study is to compare child health outcomes between telemedicine and in-person visits, also at the preventive care, acute care, and chronic care levels.
"We"re not simply looking for whether practice should or should not use telemedicine more often," said Dr. Fiks, who is also professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine. "We"re hoping to find out what types of visits would have better outcomes with telemedicine. It may be that outcomes are better with telemedicine for specific types of children or visits."
Identifying Best Practices
The third aim involves a qualitative analysis of primary care visits to determine specific characteristics that may influence the effectiveness of telemedicine. The researchers will be looking through an implementation science lens to determine the mechanisms that contribute to whether a site"s performance is higher or lower in terms of telemedicine outcomes.
"The national scope of our project will allow us to have a broad perspective on telemedicine, which in turn will inform stakeholders on how to best use telemedicine to improve quality of pediatric primary care," Dr. Fiks said. "Anecdotal evidence suggests telemedicine use has decreased since its peak use during the pandemic. But health systems have handled it in different ways, and the goal of our project is to identify the best ways to apply telemedicine to improve child health and health equity."