Document text
Principal Investigator: Alexander Gabriel Fiks
Organization: CHILDREN'S HOSP OF PHILADELPHIA
Fiscal Year: 2024
Award: $647,634
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
During the summer of 2021, 80% of pediatricians reported using live audio-video
telemedicine in the prior month, up from 16% of pediatricians with telemedicine
experience just four years before. The child health workforce now actively uses
telemedicine to care for children, but lacks evidence to guide best practices for
telemedicine use in pediatric primary care. Our research team previously found gaps in
the quality of care delivered by commercial direct-to-consumer telemedicine for the
most common acute pediatric concerns (acute respiratory tract infections). We also
demonstrated improvement in management of common chronic conditions (e.g.,
asthma, attention-deficit/hyperactivity disorder) using telemedicine in research settings.
However, the child health community lacks data regarding the use of telemedicine in
evolving “real-world” primary care practices, including how telemedicine visits compare
to in- person visits for the same conditions and how telemedicine use impacts
longitudinal outcomes for primary care patients. Additionally, we lack understanding of
the structures and processes that support primary care practices in using telemedicine
in ways that optimally enhance child health. The overarching goal of this proposal is to
identify actionable strategies for promoting the use of telemedicine within primary care
in ways that improve child health, using data from primary care practices from 2018-25.
In Aim 1, we will compare visit-level quality of primary care visits for children delivered
through telemedicine vs. in-person using electronic health record data from over 1,000
practices including independent practices, health system-affiliated practices, and
community health centers. In Aim 2, we will compare child health outcomes for children
receiving care in primary care practices with higher vs. lower telemedicine use through
comparative interrupted time series analysis of metrics related to preventive, acute, and
chronic care. Finally, in Aim 3, we will identify the practice structures and processes that
promote or impede use of telemedicine in primary care in ways that improve child
health through a qualitative multiple-case study. Through this rigorous mixed-methods
approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0
model, we will identify visit-level and child-level impact of telemedicine integration
within primary care for children as well as processes supporting health-promoting use
of telemedicine. As a result, this examination of telemedicine across preventive, acute,
and chronic care activities overall, for subpopulations, and within exemplar practices
will provide critical knowledge to inform research, practice, and policy to optimize
ongoing use of telemedicine within primary care to promote child health.
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