P1021 - Retrospective Review of Pediatric Asthma Follow-up via Telemedicine and In-person Visits

Rationale
Asthma is one of the most common pediatric chronic health conditions. Regular follow-up care as recommended by national guidelines can significantly improve asthma outcomes, and our prior pilot research suggests that telemedicine for follow-up pediatric asthma care is feasible. The goal of the current study is to examine the impact of telemedicine (TM) versus in-person (IP) asthma follow-up care on pediatric asthma outcomes.
Methods
We conducted a 2-year retrospective cohort chart review of pediatric asthma patients to examine outcomes of patients receiving follow asthma care via IP or TM at subspecialty asthma clinics at Arkansas Children’s Hospital between January 2018 - January 2020. TM visits were conducted via real-time, audiovisual conferencing and included a physician assessment, physical examination utilizing peripheral devices, and remote pulmonary function testing. Systematic random sampling was used, with a minimum of 2 follow-up visit, to assess change in outcomes. Outcomes measured were asthma control test scores (ACT), lung function, healthcare utilization, clinic attendance, travel and cost savings. Patients were matched on age, race, and gender to reduce confounding effects due to baseline demographic characteristics. To assess the financial burden on families, a cost analysis was calculated based on national averages for mileage reimbursements and minimum wage earnings. Nonparametric analyses were conducted to determine if healthcare utilization was different between TM and IP groups. A generalized estimating equation was utilized to test for differences between multiple ACT scores between groups after adjustment for multiple measures per patient.
Results
We analyzed 109 pediatric patient records (53 IP; 56 TM) for matched comparison. The mean age at baseline was 10.5 (IP) and 10.4 years (TM). Sixty percent of patients were white, 30% black, and 10% identified as other (Table 1). The majority (73%) of patients had state-issued (public) insurance. There was no significant difference in mean adjusted ACT scores between IP and TM patients over the study period, 20.9±0.50 and 21.4±0.44 respectively (p=0.41). IP patients had significantly more acute care visits for asthma during the study period compared to TM patients (IP= 13.2%, TM= 1.8% with 1 acute care visits; p= 0.0221). TM patients saved an average of 211.4 miles and 3.84 hours in travel by utilizing TM sites. TM patients saved an average of $150.50 per visit for follow-up asthma care compared to IP patients.
Conclusions
Patients followed in asthma subspecialty clinics via TM had no differences in ACT scores over the 2-year study period compared to the IP group. However, TM patients had significantly less acute care utilization, reduced travel and appreciable cost savings compared to IP patients. These findings suggest that TM is a feasible and potentially cost saving alternative to providing subspecialty pediatric asthma care.