Abstract
Objective
To assess the extent and drivers of telehealth use variation across clinicians within
the same pediatric subspecialties.
Methods
In this mixed methods study, 8 pediatric medical groups in California shared data
for eleven subspecialties. We calculated the proportion of total visits delivered
via telehealth by medical group for each subspecialty and identified the 8 most common
International Classification of Diseases 10 diagnoses for telehealth and in-person
visits in endocrinology and neurology. We conducted semi-structured interviews with
32 pediatric endocrinologists and neurologists and applied a positive deviance approach
comparing high versus low utilizers to identify factors that influenced their level
of telehealth use.
Results
In 2019, medical groups that submitted quantitative data conducted 1.8 million visits
with 549,306 unique pediatric patients. For 3 subspecialties, there was relatively
little variation in telehealth use across medical groups: urology (mean: 16.5%, range:
9%–23%), orthopedics (mean: 7.2%, range: 2%–14%), and cardiology (mean: 11.2%, range:
2%–24%). The remaining subspecialties, including neurology (mean: 58.6%, range: 8%–93%)
and endocrinology (mean: 49.5%, range: 24%–92%), exhibited higher levels of variation.
For both neurology and endocrinology, the top diagnoses treated in-person were similar
to those treated via telehealth. There was limited consensus on which clinical conditions
were appropriate for telehealth. High telehealth utilizers were more comfortable conducting
telehealth visits for new patients and often worked in practices with innovations
to support telehealth.
Conclusions
Clinicians perceive that telehealth may be appropriate for a range of clinical conditions
when the right supports are available.
Keywords
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Article info
Publication history
Published online: August 04, 2022
Accepted:
July 30,
2022
Received:
May 6,
2022
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
