From Nemours Children's Health Care System, Jacksonville, FL.
the Department of Pediatrics, Nemours Children's Hospital, Orlando, FL.
J Pediatr Gastroenterol Nutr. 2023 Sep 1;77(3):319-326. doi: 10.1097/MPG.0000000000003797. Epub 2023 Apr 20.
The purpose of our study is to compare in-person and telehealth pediatric care ambulatory visits for gastroenterology (GI) at the Nemours Children's Health System in the Delaware Valley (NCH-DV) based on geospatial, demographic, socioeconomic, and digital disparities.
Characteristics of 26,565 patient encounters from January 2019 to December 2020 were analyzed. U.S. Census Bureau geographic identifiers were assigned to each participant and aligned with the American Community Survey (2015-2019) socioeconomic and digital outcomes. Reported odds ratios (OR) are telehealth encounter/in-person encounter.
GI telehealth usage increased 145-fold in 2020 compared to 2019 for NCH-DV. Comparing telehealth to in-person usage in 2020 revealed that GI patients who required a language translator were 2.2-fold less likely to choose telehealth [individual level adjusted OR (I-OR a ) [95% confidence interval, CI], 0.45 [0.30-0.66], P < 0.001]. Individuals of Hispanic ethnicity or non-Hispanic Black or African American race are 1.3-1.4-fold less likely to utilize telehealth than non-Hispanic Whites (I-OR a [95% CI], 0.73 [0.59-0.89], P = 0.002 and 0.76 [0.60-0.95], P = 0.02, respectively). Households in census block groups (BG) that are more likely to utilize telehealth: have broadband access (BG-OR = 2.51 [1.22-5.31], P = 0.014); are above the poverty level (BG-OR = 4.44 [2.00-10.24], P < 0.001); own their own home (BG-OR = 1.79 [1.25-2.60], P = 0.002); and have a bachelor's degree or higher (BG-OR = 6.55 [3.25-13.80], P < 0.001).
Our study is the largest reported pediatric GI telehealth experience in North America that describes racial, ethnic, socioeconomic, and digital inequities. Advocacy and research for pediatric GI focused on telehealth equity and inclusion is urgently needed.
本研究旨在比较 Nemours 儿童健康系统在特拉华谷（NCH-DV）的儿科肠胃病门诊的面对面和远程医疗护理，基于地理空间、人口统计学、社会经济和数字差异。
分析了 2019 年 1 月至 2020 年 12 月期间 26565 名患者就诊的特征。为每位参与者分配了美国人口普查局的地理标识符，并与美国社区调查（2015-2019 年）的社会经济和数字结果相匹配。报告的比值比（OR）为远程医疗就诊/面对面就诊。
与 2019 年相比，2020 年 NCH-DV 的儿科肠胃病远程医疗使用率增加了 145 倍。比较 2020 年远程医疗与面对面使用情况显示，需要语言翻译的肠胃病患者选择远程医疗的可能性低 2.2 倍[个体水平调整后的比值比（I-OR a ）[95%置信区间，CI]，0.45[0.30-0.66]，P<0.001]。西班牙裔或非西班牙裔黑人和非西班牙裔白种人种族的个体使用远程医疗的可能性低 1.3-1.4 倍（I-OR a [95%CI]，0.73 [0.59-0.89]，P=0.002 和 0.76 [0.60-0.95]，P=0.02）。在普查块组（BG）中更有可能使用远程医疗的家庭：拥有宽带接入（BG-OR=2.51[1.22-5.31]，P=0.014）；处于贫困线以上（BG-OR=4.44[2.00-10.24]，P<0.001）；拥有自己的房屋（BG-OR=1.79[1.25-2.60]，P=0.002）；以及拥有学士学位或更高学历（BG-OR=6.55[3.25-13.80]，P<0.001）。
我们的研究是北美报告的最大规模儿科肠胃病远程医疗经验，描述了种族、民族、社会经济和数字不平等。迫切需要针对儿科肠胃病的远程医疗公平性和包容性进行宣传和研究。
