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A Statewide Clinic-to-Clinic Pediatric Subspecialty Telemedicine Model: Implementation, Scale, and Stakeholder
Abigail Crawford1, Margaret Jaynes1, Audra Rouster2
1Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Insights
A statewide telemedicine program successfully connected rural children with pediatric specialists, significantly reducing travel for families and improving access to care. This model enhances provider satisfaction and retention, addressing subspecialty shortages.
Area of Science:
- Health Services Research
- Telemedicine
- Pediatric Subspecialty Care
Background:
- Children in rural and underserved areas face significant barriers accessing pediatric subspecialty care.
- Traditional models often require extensive travel, leading to decreased access and increased burden on families.
- Innovative healthcare delivery models are needed to bridge these geographic and access gaps.
Purpose of the Study:
- To evaluate the implementation, scale, and stakeholder experience of a statewide clinic-to-clinic pediatric subspecialty telemedicine program.
- To assess the program's impact on access to care for children in rural and underserved communities.
- To analyze the reduction in travel burden for families and the satisfaction of involved stakeholders.
Main Methods:
- Development of a hub-and-spoke telemedicine network connecting a children's hospital with regional clinics.
- Implementation of a hybrid clinic-to-clinic model where Advanced Practice Providers (APPs) conducted in-person assessments and facilitated telemedicine consultations.
- Analysis of program utilization, travel burden reduction (miles, hours, CO2 emissions), and parent/provider feedback through surveys and qualitative content analysis.
Main Results:
- Over 21,800 visits were completed across 21 subspecialties between 2018-2024, involving 98 clinicians.
- Families avoided an estimated 5.9 million travel miles, 99,000 travel hours, and 2,400 metric tons of CO2 emissions.
- 90% of parents rated care as excellent, with providers citing improved access, trust, and communication as key success factors; operational sustainability varied by site type.
Conclusions:
- A clinic-to-clinic telemedicine model with trained APPs effectively expands pediatric subspecialty access.
- The program significantly reduces travel burden, enhances provider satisfaction, and supports retention.
- This scalable hybrid framework offers a viable solution for health systems facing geographic barriers and subspecialty shortages.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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