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Visits of concern in child neurology telemedicine
Marisa Prelack1,2, Sara Fridinger1,2, Alexander K Gonzalez1,3,4
1Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Most child neurology telemedicine visits were successful, but younger children and those with neuromuscular disorders or developmental delays were more likely to need in-person follow-up. Telemedicine remains an effective tool for pediatric neurology care.
Area of Science:
- Pediatric Neurology
- Telemedicine
- Health Services Research
Background:
- The COVID-19 pandemic necessitated a rapid shift to telemedicine for child neurology consultations.
- Understanding the characteristics of telemedicine visits requiring in-person evaluation is crucial for optimizing care delivery.
Purpose of the Study:
- To characterize child neurology telemedicine visits that were flagged as requiring in-person evaluation during the COVID-19 pandemic.
Main Methods:
- Analysis of 7130 audio-video telemedicine visits between March and November 2020.
- Definition of Visits of Concern (VOCs) as telemedicine visits necessitating sooner in-person follow-up than if conducted in-person.
- Comparison of demographic and clinical factors between VOCs and non-VOCs.
Main Results:
- Visits of Concern (VOCs) occurred in 5% of visits.
- VOCs were more frequent in younger children, those with lower median household income, and Black families.
- Epilepsy and headache were common reasons for VOCs, alongside a higher proportion of VOCs for neuromuscular disorders and developmental delays.
Conclusions:
- Telemedicine is largely effective for child neurology, but specific patient groups require careful consideration for in-person assessment.
- Younger age, neuromuscular disorders, and developmental delays are key factors associated with the need for in-person evaluation.
- The identification and flagging of concerning telemedicine visits are feasible and largely independent of technical difficulties.
Aim:
To characterize child neurology telemedicine visits flagged as requiring in-person evaluation during the COVID-19 pandemic.
Method:
We analyzed 7130 audio-video telemedicine visits between March and November 2020. Visits of concern (VOCs) were defined as telemedicine visits where the clinical scenario necessitated in-person follow-up evaluation sooner than if the visit had been conducted in-person.
Results:
VOCs occurred in 5% (333/7130) of visits for 292 individuals (148 females, 144 males). Providers noted technical challenges more often in VOCs (40%; 133/333) than visits without concern (non-VOCs) (28%; 1922/6797) (p < 0.05). The median age was younger in VOCs (9 years 3 months, interquartile range [IQR] 2 years 0 months-14 years 3 months) than non-VOCs (11 years 3 months, IQR 5 years 10 months-15 years 10 months) (p < 0.05). Median household income was lower for patients with VOCs ($74 K, IQR $55 K-$97 K) compared to non-VOCs ($80 K, IQR $61 K-$100 K) (p < 0.05). Compared with all other race categories, families who self-identified as Black were more likely to have a VOC (odds ratio 1.53, 95% confidence interval 1.21-2.06). Epilepsy and headache represented the highest percentages of VOCs, while neuromuscular disorders and developmental delay had a higher proportion of VOCs than other neurological disorders.
Interpretation:
These findings suggest that telemedicine is an effective platform for most child neurology visits. Younger children and those with neuromuscular disorders or developmental delays are more likely to require in-person evaluation.
What This Paper Adds:
It is possible to successfully flag patients who need in-person assessment. Providers can manage issues arising during telemedicine in 95% of visits. Visits flagged as concerning were likely unrelated to modality of patient care. Provider concern was independent of technical difficulties for most telehealth visits. Younger age may be correlated with need for in-person assessment.
