Equity and Inclusion in Pediatric Gastroenterology Telehealth: A Study of Demographic, Socioeconomic, and Digital
Edward B Mougey1, Wesley C Judy2, Rajitha D Venkatesh3,4
1From Nemours Children's Health Care System, Jacksonville, FL.
Insights
Pediatric gastroenterology telehealth use surged, but disparities persist. Patients needing translators and minority groups were less likely to use telehealth, highlighting the need for equitable access.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Telehealth Equity
Background:
- Telehealth adoption in pediatric gastroenterology (GI) has rapidly increased.
- Understanding disparities in telehealth access is crucial for equitable healthcare delivery.
- Previous research has not extensively detailed these disparities in pediatric GI settings.
Purpose of the Study:
- To compare in-person and telehealth pediatric gastroenterology ambulatory visits.
- To analyze geospatial, demographic, socioeconomic, and digital disparities in telehealth utilization.
- To identify factors influencing access to pediatric GI telehealth services.
Main Methods:
- Analysis of 26,565 pediatric GI patient encounters from January 2019 to December 2020.
- Geospatial and socioeconomic data linked using U.S. Census Bureau and American Community Survey.
- Calculation of odds ratios to compare telehealth vs. in-person visits based on patient and geographic characteristics.
Main Results:
- Telehealth usage increased 145-fold in 2020.
- Patients requiring language translators were 2.2 times less likely to use telehealth.
- Hispanic and Black patients were less likely to use telehealth compared to White patients.
- Telehealth use was higher in areas with broadband access, higher income, homeownership, and higher education levels.
Conclusions:
- This is the largest North American study on pediatric GI telehealth, revealing significant inequities.
- Racial, ethnic, socioeconomic, and digital disparities impact telehealth access in pediatric GI care.
- Urgent advocacy and research are needed to promote telehealth equity and inclusion in pediatric gastroenterology.
Objectives:
The purpose of our study is to compare in-person and telehealth pediatric care ambulatory visits for gastroenterology (GI) at the Nemours Children's Health System in the Delaware Valley (NCH-DV) based on geospatial, demographic, socioeconomic, and digital disparities.
Methods:
Characteristics of 26,565 patient encounters from January 2019 to December 2020 were analyzed. U.S. Census Bureau geographic identifiers were assigned to each participant and aligned with the American Community Survey (2015-2019) socioeconomic and digital outcomes. Reported odds ratios (OR) are telehealth encounter/in-person encounter.
Results:
GI telehealth usage increased 145-fold in 2020 compared to 2019 for NCH-DV. Comparing telehealth to in-person usage in 2020 revealed that GI patients who required a language translator were 2.2-fold less likely to choose telehealth [individual level adjusted OR (I-OR a ) [95% confidence interval, CI], 0.45 [0.30-0.66], P < 0.001]. Individuals of Hispanic ethnicity or non-Hispanic Black or African American race are 1.3-1.4-fold less likely to utilize telehealth than non-Hispanic Whites (I-OR a [95% CI], 0.73 [0.59-0.89], P = 0.002 and 0.76 [0.60-0.95], P = 0.02, respectively). Households in census block groups (BG) that are more likely to utilize telehealth: have broadband access (BG-OR = 2.51 [1.22-5.31], P = 0.014); are above the poverty level (BG-OR = 4.44 [2.00-10.24], P < 0.001); own their own home (BG-OR = 1.79 [1.25-2.60], P = 0.002); and have a bachelor's degree or higher (BG-OR = 6.55 [3.25-13.80], P < 0.001).
Conclusions:
Our study is the largest reported pediatric GI telehealth experience in North America that describes racial, ethnic, socioeconomic, and digital inequities. Advocacy and research for pediatric GI focused on telehealth equity and inclusion is urgently needed.
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