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Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries

Authors
  • Ray, Kristin N1
  • Mehrotra, Ateev2, 3
  • Yabes, Jonathan G4
  • Kahn, Jeremy M5, 6
  • 1 Department of Pediatrics (KN Ray), University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pa
  • 2 Department of Health Care Policy (A Mehrotra), Harvard Medical School, Boston, Mass
  • 3 RAND Corporation (A Mehrotra), Boston, Mass
  • 4 Departments of Biostatistics and Medicine (JG Yabes), University of Pittsburgh School of Medicine, Pittsburgh, Pa
  • 5 Department of Health Policy and Management (JM Kahn), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa
  • 6 Department of Critical Care Medicine (JM Kahn), University of Pittsburgh School of Medicine, Pittsburgh, Pa
Type
Published Article
Journal
Academic Pediatrics
Publisher
by Academic Pediatric Association
Publication Date
Apr 08, 2020
Volume
20
Issue
5
Pages
642–651
Identifiers
DOI: 10.1016/j.acap.2020.03.014
PMID: 32278078
PMCID: PMC7194998
Source
PubMed Central
Keywords
License
Unknown

Abstract

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 ≤17 years old in 2014 Medicaid Analysis eXtract data for 12 states. We identified telemedicine-using and telemedicine-nonusing medical and surgical subspecialists. Among children cared for by telemedicine-using subspecialists, we assessed child and subspecialist characteristics associated with any telemedicine visit using logistic regression with subspecialist-level random effects. Among children cared for by telemedicine-using and nonusing subspecialists, we compared visit rates across child characteristics by assessing negative binomial regression interaction terms. Results Of 12,237,770 pediatric Medicaid beneficiaries, 2,051,690 (16.8%) had ≥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.

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