(O-I5) Factors Associated with Conversion to In-person Visit Among Patients Presenting for Pediatric Telehealth Encounters

Objectives: To identify patient and illness related factors associated with conversion to in-person visits among children presenting for pediatric telehealth encounters.

Background: Increases in telehealth utilization during the COVID-19 pandemic have been driven by limited availability of office visits due to infection prevention guidelines, parental hesitancy to enter healthcare facilities, and parity in reimbursement for providers. Due to increased demand and limited number of telehealth providers, it is important to determine which children may benefit the most from these encounters.

Methods: In this retrospective case-control study, patients 0-21 years old presenting for a telehealth encounter were evaluated. Children who had an in-person visit within 7 days of the telehealth visit were identified as conversion cases and matched in a 1:3 ratio to controls by age in months up to 36 months and by year for those 4 and older. Patient demographics, past medical history, symptoms, and diagnoses were collected. A multivariable logistic regression model was developed including variables significantly associated with conversion on univariate analysis.

Results: From March to April 2020, there were 2,465 pediatric telehealth encounters. Of these, there were 67 (3%) conversions to in-person visits. 79% of these conversions originated from general pediatric telehealth encounters and the remaining from subspecialty telehealth visits. 69% of these conversions were to the ED and 31% in the clinic. Median days to in-person visit was 2 (1, 5). Median age was 25 months (1, 172), 66% were female, and 43% had a chronic medical condition. 55% were uninsured or on Medicaid and remaining were commercially insured. The most common symptoms reported included: 42% respiratory, 22% fever, 19% pain, 18% vomiting/diarrhea, and 18% rash. After matching with controls based on age, a multivariable logistic regression model revealed that a history of cancer (OR 15.8, 95% CI 1.3-195.0), emesis (OR 4.6, 95% CI 1.1-18.9), pain (OR 4.5, 95% CI 1.5-13.3), non-COVID related respiratory symptoms (OR 3.9, 95% CI 1.5-9.7), and telehealth visit with a specialist in Allergy, Endocrinology, Gastroenterology, or Pulmonary (OR 0.3, 95% CI 0.1-0.7) were associated with conversion, with an AUC of 0.82.

Conclusions: This introductory evaluation may suggest that certain patient and illness related factors are associated with telehealth conversion to in-person encounters. In order to appropriately allocate telehealth and ambulatory resources, further study will determine if some children will benefit if they are triaged directly to in-person visits.

References (Optional):

Funding (Optional): n/a