Telehealth triage in pediatric rheumatology: a diagnostically accurate tool to improve access to care.

OBJECTIVES

During the SARS-CoV-2 pandemic, new patient evaluations in pediatric rheumatology were performed using telehealth. Given the pediatric rheumatology workforce shortage, telehealth may be a way to efficiently triage referrals. The objective was to assess the utility of telehealth visits as a diagnostic tool to accurately assess the need for in-person evaluation.

METHODS

This was a retrospective cohort study of patients evaluated by telehealth for a new patient visit from March 1 to June 30, 2020 at a tertiary center. Electronic health record documentation from subsequent rheumatology, specialty, and primary care encounters over the subsequent 4 years were reviewed. The primary outcome was diagnostic concordance, defined as consistency in the documented diagnostic reasoning, between the initial telehealth video visit and in-person follow-up visits.

RESULTS

During the study period, there were 111 telehealth visits, 80 (72 %) of which had follow-up data. 55/80 had in-person rheumatology evaluations. Only 9 % patients had discordant diagnoses, all of whom had initial concern for inflammatory arthritis during the telehealth visit but a diagnosis of a non-inflammatory condition after in-person evaluation. Nine patients with a significant rheumatic disease were identified via telehealth. There were no unplanned ED visits or hospital admissions following telehealth visits. 33 % of patients were found to not warrant rheumatologic follow-up after the telehealth visit.

CONCLUSIONS

For pediatric rheumatology new patient evaluations, diagnostic accuracy via telehealth evaluation was high. Providers triaged patients with chronic rheumatologic conditions for in-person evaluations and were able to accurately identify benign conditions that did not require in-person follow-up.