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Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era
Ruth M Vaughan1,2, Judson A Moore3,4,5, Jasmine S Moreno4
1Department of Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX, 77030, USA. armorrison@me.com.
Insights
Remote care use, including telemedicine and patient portal adoption, increased for pediatric cardiology patients during the COVID-19 pandemic. Older children and those with public insurance or who spoke Spanish showed higher adoption rates, suggesting potential to reduce care disparities.
Area of Science:
- Cardiology
- Health Services Research
- Digital Health
Background:
- The COVID-19 pandemic necessitated a shift towards remote healthcare delivery, impacting access to care for vulnerable populations.
- Complex pediatric cardiology patients, particularly those with congenital heart disease (CHD), faced challenges with in-person appointment restrictions.
Purpose of the Study:
- To assess the adoption and accessibility of remote care services, specifically telemedicine and patient portal use, among established pediatric cardiology outpatients.
- To identify demographic and socioeconomic factors associated with the utilization of remote care technologies in pediatric cardiology.
Main Methods:
- Retrospective chart review of 5,410 pediatric cardiology outpatient appointments at Texas Children's Hospital from March to December 2020.
- Analysis of telemedicine adoption (13% of patients) and patient portal activation (4.5% of prior non-users).
- Multivariate logistic regression to determine associations between patient characteristics (age, insurance, race/ethnicity, language, location) and remote care use.
Main Results:
- Older children (10-17 years) demonstrated significantly higher rates of telemedicine (OR 2.04) and patient portal use (OR 1.70).
- Patients with public insurance (OR 1.66) and those who were Spanish-speaking showed increased patient portal adoption.
- No significant association was found between race/ethnicity and the adoption of telemedicine or patient portal use.
Conclusions:
- Telehealth adoption in older pediatric cardiology patients may reflect their capacity to engage with these technologies.
- Increased patient portal activation among publicly insured and Spanish-speaking individuals is promising for remote care navigation.
- Expanding remote patient care options holds potential for mitigating access-to-care disparities in pediatric cardiology.
Abstract:
The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. We performed a retrospective chart review of Texas Children's Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use (p < 0.05). We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients (n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10-17 yo) was associated with increased telemedicine (OR 2.04, 95%CI 1.71, 2.43) and patient portal use (OR 1.70, 95%CI 1.33, 2.17). Public insurance (OR 1.66, 95%CI 1.25, 2.20) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities.
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