A Statewide Clinic-to-Clinic Pediatric Subspecialty Telemedicine Model: Implementation, Scale, and Stakeholder...

To describe the implementation, scale, and stakeholder experience of a statewide clinic-to-clinic pediatric subspecialty telemedicine program improving access to care for children in rural and underserved communities.

A hub-and-spoke telemedicine network was developed linking pediatric subspecialists at an academic children's hospital with advanced practice providers (APPs) at five regional spoke clinics. In this hybrid clinic-to-clinic model, APPs performed in-person assessments and facilitated synchronous telemedicine consultations for all new patients. Program utilization, travel burden reduction, and parent survey responses were analyzed descriptively; free-text parent comments and a provider panel discussion underwent qualitative content analysis.

From 2018 through 2024, the program completed 21,838 visits across 21 pediatric subspecialties, involving 98 clinicians. Families avoided an estimated 5.9 million travel miles, 99,000 travel hours, and approximately 2,400 metric tons of CO₂ emissions. Among 251 surveys returned, 90.0% of the 239 parents answering the rating item rated care as excellent and 8.8% as good. Providers attributed the model's success to deliberate program infrastructure and standardization, strong trust and communication between subspecialists and site APPs, and improved access to timely subspecialty care closer to home. Full-time spoke sites achieved operational sustainability, whereas part-time sites were limited by staffing and workflow barriers.

A clinic-to-clinic telemedicine model incorporating trained APPs at the point of care can sustainably expand pediatric subspecialty access while reducing travel burden and supporting provider satisfaction and retention. This scalable hybrid framework may help health systems address geographic barriers and pediatric subspecialty shortages.