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Widening Racial Disparities During COVID-19 Telemedicine Transition: A Study of Child Mental Health Services at Two
J Corey Williams1, Molly Ball2, Nora Roscoe2
1MedStar Georgetown University Hospital, Washington, DC.
Insights
The COVID-19 telemedicine shift worsened racial disparities in pediatric mental health care access. Racially minoritized children experienced reduced access, particularly in urban settings, highlighting unequal healthcare resource distribution.
Area of Science:
- Pediatric Health Services Research
- Health Equity Studies
- Telemedicine Implementation
Background:
- The COVID-19 pandemic necessitated a rapid transition to telemedicine for healthcare services.
- Pre-existing racial disparities in access to pediatric mental health care are a significant public health concern.
- Understanding the impact of telemedicine on these disparities is crucial for ensuring equitable care.
Purpose of the Study:
- To investigate if the shift to telemedicine during COVID-19 exacerbated racial disparities in pediatric mental health care access.
- To compare changes in access for racially minoritized versus White-identifying children at two major children's hospitals.
- To identify potential risks for specific patient populations during telemedicine implementation.
Main Methods:
- Electronic health records from The Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH) were analyzed.
- Outpatient visit data from pre-pandemic (2019) and pandemic (2020) periods were compared.
- Logistic regression analyses controlled for insurance status and clinic location to assess changes in patient proportions by race.
Main Results:
- At CHOP, the proportion of racially minoritized patients decreased significantly from 62% to 51% between 2019 and 2020.
- At BCH, a significant decline in racially minoritized patients from 62% to 59% was observed over a longer period in 2020.
- Concurrently, the proportion of White-identifying patients increased at both institutions, indicating a widening gap in access.
Conclusions:
- The transition to telemedicine during COVID-19 exacerbated existing racial disparities in pediatric mental health care at CHOP and BCH.
- Racially minoritized patients in urban areas may face heightened risks of reduced access with telemedicine adoption.
- Findings underscore the need for strategies to mitigate unequal healthcare resource distribution and ensure equitable telemedicine access for all children.
Objective:
To examine whether racial disparities in access to pediatric mental health care were affected during the COVID-19 telemedicine transition at both The Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH).
Method:
Electronic health records were queried for all unique outpatient visits from a pre-pandemic period in 2019 and a within-pandemic period in 2020. Changes in the proportion of patients were compared based on insurance status, clinic location, and racial identification. Hypotheses were tested via logistic regression analyses.
Results:
At CHOP, from 2019 to 2020, the proportion of racially minoritized patients significantly declined within a 1-month period from 62% to 51%, whereas the proportion of White-identifying patients increased from 38% to 49% (β = 0.47; z = 3.60; p =.0003), after controlling for insurance status and clinic location. At BCH, the proportion of racially minoritized patients significantly declined within a longer 6-month period between 2019 and 2020, from 62% to 59%, whereas the proportion of White-identifying patients increased from 38% to 41% (β = 0.13; z = 2.8; p = .006), after controlling for insurance status.
Conclusion:
At CHOP and BCH, the COVID-19 telemedicine transition exacerbated pre-existing racial disparities in pediatric mental health services. Our findings suggest that racially minoritized patients receiving services in urban areas may be particularly at risk for losing access when telemedicine is implemented. Although there are limitations to this racial dichotomization, examining differences between White and racially minoritized patients can highlight ways in which White-identifying individuals have disproportionately received enhanced access to healthcare resources.
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