Comparing Family Decision Making Engagement in Telehealth versus In-person Primary Care for Children with Chronic Conditions

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PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic led to unprecedented changes to healthcare delivery during the spring of 2020, including the rapid and wide implementation of telehealth. This expansion included areas in which telehealth had not previously been broadly applied, such as pediatric primary care. By its very nature, telehealth changes the communication and structure of the healthcare interaction, perhaps especially in pediatrics where both the parent and patient need to be engaged in the visit. Such changes may directly affect shared decision making, an essential component of high-quality care and a strategy to improve outcomes. Children with asthma and attention deficit hyperactivity disorder, the most common chronic conditions in pediatric primary care, are especially vulnerable to changes in health care delivery. These conditions are highly prevalent among urban, underserved children and while some barriers to care are alleviated by telehealth new ones may emerge. Understanding the impact of telehealth on an underserved, inner-city, primary care population is critical to prevent worsening disparities. Our long-term goal is to improve pediatric primary care by ensuring delivery of chronic disease care that meets families’ goals and improves children’s health and well-being. The overall objective of this proposal is to compare the decision-making processes and outcomes between telehealth and in-person pediatric primary care for children with chronic conditions. This proposal consists of three distinct aims that build upon one another by triangulating perceived and observed decision-making, parents’ and adolescent patients’ perceptions, and quantitative and qualitative data to achieve breadth and depth of understanding about shared decision making in pediatric primary care. In Aims 1 and 2 we will evaluate the quality of pediatric primary care delivered via telehealth compared to in-person care. Aim 1 will use rigorous survey methods to understand families’ perceptions of decision making that occurs during either a telehealth or in-person pediatric primary care visit. This will be coupled with chart review to understand the contribution of telehealth or in-person care to clinical outcomes. Aim 2 will build upon the first by video-recording healthcare visits so the extent of observed shared decision making can be assessed both quantitatively and qualitatively. Finally, in aim 3 we will use qualitative interviews to “feed forward” the data from aims 1 and 2 to parents, adolescents and healthcare providers to gain a more in-depth understanding regarding experiences of decision making in telehealth compared to in-person care. The expected outcome of this proposal is an understanding of the impact of telehealth delivery in pediatric primary care on decision making processes for children with chronic conditions. These results will have a positive impact on care delivery by facilitating the development of targeted approaches to supporting shared decision making as healthcare systems continue evolve and integrate telehealth.