Urban Telemedicine Enables Equity in Access to Acute Illness Care
Sarah D Ronis1, Kenneth M McConnochie2, Hongyue Wang3
11 Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, UH Rainbow Babies and Children's Hospital , Cleveland, Ohio.
Insights
Telemedicine access improved acute care use for inner-city children, reducing disparities with suburban children. This enhanced healthcare equity by providing comparable access to care.
Area of Science:
- Healthcare access
- Telemedicine
- Pediatric care
Background:
- Children with telemedicine access had 22% less emergency department use but 24% greater overall acute care use.
- Previous findings indicated a complex utilization pattern with telemedicine implementation.
Purpose of the Study:
- To test if telemedicine improved access for impoverished inner-city children to levels seen in affluent suburban children.
- To analyze the impact of telemedicine on acute care utilization across different socioeconomic groups.
Main Methods:
- Observational study comparing children with and without telemedicine access from 1993-2007.
- Utilized billing claims data (84,287 child-months) and adjusted for age, sex, insurance, and season.
- Health-e-Access Telemedicine implemented stepwise across 74 sites (childcare, schools, community centers).
Main Results:
- Before telemedicine, suburban children had 75% more acute visits than inner-city children.
- After telemedicine, inner-city children's acute visits became comparable to suburban levels (rate ratio 0.80).
- Suburban children without telemedicine access still had 56% more acute visits than inner-city counterparts.
Conclusions:
- Health-e-Access Telemedicine reduced socioeconomic disparities in acute care access.
- The model contributed to a more equitable healthcare distribution in the Rochester area.
- Telemedicine effectively improved access for underserved inner-city pediatric populations.
Background:
Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall.
Introduction:
We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation.
Materials And Methods:
Health-e-Access Telemedicine was initiated in stepwise manner over 187 study-months among 74 access sites (childcare, schools, community centers), beginning in month 105. Children dwelled in inner city, rest-of-city Rochester, NY, or in surrounding suburbs. Rate of total acute care visits (office, ED, telemedicine) was measured as visits per 100 child-years. Observed utilization rates were adjusted in multivariate analysis for age, sex, insurance type, and season of year.
Results:
When both suburban and inner-city children lacked telemedicine access, overall acute illness visits were 75% greater among suburban than inner-city children (suburban:inner-city rate ratio 1.75, p < 0.0001). After telemedicine became available to inner-city children, their overall acute visits approximated those of suburban children (suburban:inner-city rate ratio 0.80, p = 0.07), whereas acute visits among suburban children remained at least (worst-case comparison) 56% greater than inner-city children without telemedicine (rate ratio 1.56, p < 0.0001).
Discussion:
At baseline, overall acute illness utilization of suburban children exceeded that of inner-city children. Overall utilization for inner-city children increased with telemedicine to that of suburban children at baseline. Without telemedicine, however, inner-city use remained substantially less than for suburban counterparts.
Conclusions:
Health-e-Access Telemedicine redressed socioeconomic disparities in acute care access in the Rochester area, thus contributing to a more equitable community.
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