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Disparities in Telehealth Uptake for Developmental-Behavioral Pediatric Assessments by Preferred Family Language: A
Kate E Wallis1,2,3,4, Annie Kennelly5, Sarah N Wozniak1,3
1PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Telehealth use in developmental-behavioral pediatric (DBP) assessments during COVID-19 favored English speakers. Families with a preferred language other than English (PLOE) had lower telehealth utilization, highlighting an equity gap in care access.
Area of Science:
- Pediatrics
- Health Equity
- Telemedicine
Background:
- The COVID-19 pandemic necessitated rapid adoption of telehealth in developmental-behavioral pediatric (DBP) practices.
- Ensuring equitable access to telehealth services for all families, including those with a preferred language other than English (PLOE), is a significant concern.
Purpose of the Study:
- To compare telehealth utilization and visit completion rates between English-speaking families and families with a PLOE for DBP assessments during the COVID-19 pandemic.
Main Methods:
- A descriptive chart review of electronic health records from 4 academic DBP practices was conducted.
- Data included new-patient appointments for children up to 5 years old between April 2020 and April 2021.
- Analysis compared in-person vs. telehealth visits and visit outcomes (completed/missed) by preferred family language.
Main Results:
- Telehealth was utilized for 51.8% of the 3241 scheduled visits.
- English-speaking patients were 2.10 times more likely to be scheduled for telehealth compared to patients with PLOE.
- Visit completion rates did not differ significantly between in-person and telehealth visits, regardless of preferred language.
Conclusions:
- During the pandemic, telehealth was disproportionately used for English-speaking families in DBP evaluations.
- Fewer families with PLOE accessed telehealth services, indicating a potential barrier to care.
- Addressing language barriers is crucial for ensuring equitable telehealth access in DBP care.
Objective:
Owing to the coronavirus disease 2019 (COVID-19) pandemic, many developmental-behavioral pediatric (DBP) practices adopted telehealth for care delivery. However, telehealth access and use for families with a preferred language other than English (PLOE) is an equity concern. Therefore, our study objective is to compare rates of telehealth utilization and visit completion by preferred family language among patients seen for DBP assessments during the COVID-19 pandemic.
Methods:
We completed a descriptive chart review using electronic health record data at 4 academic DBP practices to examine visits for patients up to 5 years seen for new-patient appointments between April 2020 and April 2021. We compared rates of in-person and telehealth visits by preferred family language and visit outcome (completed or missed).
Results:
A total of 3241 visits were scheduled between April 2020 and April 2021; 48.2% were for in-person and 51.8% for telehealth. Families reported the following languages: 90.5% English, 6.2% Spanish, and 3.3% other language. Missed visits accounted for 7.6% of scheduled visits. The relative percentage of in-person versus telehealth visits varied significantly by site (p < 0.001) and preferred family language (p < 0.001). English-speaking patients had 2.10 times the odds of being scheduled for telehealth compared with patients with PLOE, adjusting for site. Statistically significant differences were not found for visit outcome (completed or missed) by visit type (in-person or telehealth) (p = 0.79), including after accounting for PLOE status (p = 0.83).
Conclusion:
At the height of the pandemic, most English-speaking families were scheduled for new DBP evaluations by telehealth, but fewer families with PLOE were. Attention to language to ensure telehealth access equity is critical.
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