Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries
Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries
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DOI：
10.1016/j.acap.2020.03.014
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发表时间：
2020-07-01
影响因子：
3.1
通讯作者：
Kahn, Jeremy M.
中科院分区：
文献类型：
--
作者：
Ray, Kristin N.;Mehrotra, Ateev;Kahn, Jeremy M.
目的：实时互动远程医疗越来越多地被国家医疗补助计划覆盖，但远程医疗是否正在改善亚专科护理利用的公平性尚不清楚。我们检查了远程医疗在国家医疗补助计划中用于门诊儿科亚专科护理的模式。方法：我们确定儿童= 1次专科就诊。在确定的42,695个专科医生中，146个（0.3%）有>= 1远程医疗索赔。在接受使用远程医疗的专科医生护理的儿童中，农村儿童使用远程医疗的可能性增加（优势比[OR] 10.4, 95%置信区间[CI] 6.3-17.1，与大城市参照组相比）和距离专科医生90英里的儿童（优势比[OR] 13.4, 95%置信区间[CI] 10.2-17.7，与0-30英里参照组相比）。与接受非远程医疗亚专家护理的儿童相比，接受远程医疗亚专家护理的匹配儿童在就诊距离、县农村、邮政编码中位数收入和儿童种族/民族方面的就诊率差异更大（交互项P < 0.001）。结论：农村社区的儿童和距离专科医生较远的儿童使用远程医疗的可能性增加。总体使用率较低，结果表明早期远程医疗政策和实施并没有缩小儿童地理和社会人口特征在亚专科就诊率方面的差异。
OBJECTIVE: Live interactive telemedicine is increasingly covered by state Medicaid programs, but whether telemedicine is improving equity in utilization of subspecialty care is not known. We examined patterns of telemedicine use for outpatient pediatric subspecialty care within the state Medicaid programs.METHODS: We identified children = 1 subspecialist visit. Of 42,695 subspecialists identified, 146 (0.3%) had >= 1 telemedicine claim. Among children receiving care from telemedicine-using subspecialists, likelihood of any telemedicine use was increased for rural children (odds ratio [OR] 10.4, 95% confidence interval [CI] 6.3-17.1 compared to large metropolitan referent group) and those >90 miles from the subspecialist (OR 13.4, 95% CI 10.2-17.7 compared to 0-30 mile referent group). Compared to children receiving care from telemedicine-nonusing subspecialists, matched children receiving care from telemedicine-using subspecialists had larger differences in visit rates by distance to care, county rurality, ZIP code median income, and child race/ethnicity (P < .001 for interaction terms).CONCLUSIONS: Children in rural communities and at distance to subspecialists had increased likelihood of telemedicine use. Use overall was low, and results indicated that early telemedicine policies and implementation did not close disparities in subspecialty visit rates by child geographic and sociodemographic characteristics.