Division of General Pediatrics, Department of Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
J Dev Behav Pediatr. 2022;43(5):297-302. doi: 10.1097/DBP.0000000000001040. Epub 2022 Feb 24.
The goal of this study was to understand the effect of transition to telehealth care on follow-up visit attendance in a developmental-behavioral pediatric (DBP) practice in 2020 versus in-person care in 2019.
This was a retrospective observational cohort study of follow-up visits occurring in a large DBP practice during a 6-week period in March/April of 2019 and 2020. The primary outcome was follow-up visit adherence, defined as completion of scheduled follow-up visit. The primary exposure was telehealth visit in 2020 versus in-person visit in 2019. Covariates included patient demographics and clinical characteristics. Data were analyzed using descriptive statistics and logistic regression.
The cohort included 2142 visits for 1868 unique patients. The patient mean age was 9.2 ± 4.8 years, with 73.4% male, 56.5% non-Hispanic, 51.4% White, and 68.3% commercial insurance. There were 470 telehealth visits from March to April 2020 and 1672 in-person visits from March to April 2019. Compared with in-person visits, telehealth visits were more likely to be completed (75.3% vs 64.4%, p < 0.001). After adjusting for age, sex, race, ethnicity, insurance, and week of visit (weeks 1-3 vs 4-6), odds of having a complete follow-up visit were higher for telehealth visits than for in-person visits (odds ratio = 1.57; 95% confidence interval [1.23-2.00], p < 0.001).
Follow-up visit attendance was higher for telehealth care in 2020 than in-person care in 2019. This association persisted after adjusting for insurance, age, race, and ethnicity, suggesting that telehealth is associated with increased follow-up visit attendance in DBP care. Further studies are needed to understand the impact of telehealth on DBP clinical outcomes in chronic disease management.
本研究旨在了解 2020 年向远程医疗过渡对发育行为儿科学（DBP）实践中随访就诊率的影响，与 2019 年的面对面就诊进行比较。
这是一项回顾性观察性队列研究，对 2019 年 3 月至 4 月和 2020 年 3 月至 4 月期间在一家大型 DBP 诊所进行的 6 周随访就诊情况进行了研究。主要结局是随访就诊的依从性，定义为完成计划的随访就诊。主要暴露因素是 2020 年的远程医疗就诊与 2019 年的面对面就诊。协变量包括患者人口统计学和临床特征。使用描述性统计和逻辑回归分析数据。
该队列包括 2142 次就诊，涉及 1868 名患者。患者的平均年龄为 9.2±4.8 岁，男性占 73.4%，非西班牙裔占 56.5%，白人占 51.4%，商业保险占 68.3%。2020 年 3 月至 4 月期间有 470 次远程医疗就诊，2019 年 3 月至 4 月期间有 1672 次面对面就诊。与面对面就诊相比，远程医疗就诊更有可能完成（75.3% vs 64.4%，p<0.001）。在校正年龄、性别、种族、民族、保险和就诊周数（第 1-3 周与第 4-6 周）后，远程医疗就诊的完全随访就诊率高于面对面就诊（优势比=1.57；95%置信区间[1.23-2.00]，p<0.001）。
2020 年远程医疗就诊的随访就诊率高于 2019 年的面对面就诊。在校正保险、年龄、种族和民族因素后，这种关联仍然存在，表明远程医疗与 DBP 护理中的随访就诊率增加有关。需要进一步研究以了解远程医疗对慢性病管理中 DBP 临床结局的影响。
