P1017 - Rapid adoption of telehealth due to the COVID-19 pandemic in a large urban Federally Qualified Health Center – adapting the pediatric model to care for patients in need

Background/Program Goals: The COVID-19 pandemic has led to a significant decline in the numbers of ambulatory healthcare visits in the US, with pediatricians seeing 62% fewer patients during the first week in April than the first week in March. (Adult/OB outpatient visits have declined 45-50%.) Nationwide, during April 2020, it is estimated that approximately 30% of ambulatory visits were carried out via telehealth.
Inner-city children in Chicago live in families that are disproportionately impacted by the COVID-19 pandemic. Our Chicago-land Federally Qualified Health Center (FQHC), which serves over 80,000 patients and at baseline provided over 6,000 weekly in-person visits (patient panel is 47% children/adolescents, > 90% low income, 71% Hispanic/Latino) is markedly changing our care model, including a rapid shift to telehealth, in order to maintain needed services for our patients. The services provided by our FQHC pediatricians are also changing in order to meet our FQHC’s patient’s needs during this time.

Evaluation: review of PDSA cycles, qualitative/quantitative feedback from staff and patients/families, clinical quality data

Discussion:
(1) From mid-March to mid-April 2020, visit volume at our FQHC initially fell by 75% but now is approximately 85% of pre-COVID volume. No medical and only a few behavioral health visits were by telehealth prior to March. We will describe how we used a plan-do-study-act (PDSA) approach to change our care delivery model so that 75% of visits are now being delivered partially or completely via telehealth.
(2) In the same period, our FQHC saw a shift in the age of patients accessing our call center with 2/3 of the requests for healthcare now from patients over age 18 (before COVID-19, over half of all calls were for patients under age 18). Pediatricians at our FQHC now provide telehealth visits for patients through age 25 (with structured support in place from our adult/family medicine colleagues and informal continuing medical education on young adult topics as needed) in order to meet current patient demand.
(3) Targeted outreach to patients under age 2 for vaccinations, and for all ages with special health care needs or chronic illness (including asthma), has been a successful approach to maintaining ambulatory/telehealth visit volume for pediatricians.
(4) All telehealth visits include a one-question social needs assessment screener. Approximately 40% of patients screen positive and are being linked with appropriate resources in their communities by FQHC staff.
(5) As an FQHC, we report quality metrics including pediatric immunization rates, nutrition/activity counseling and adolescent depression screening. These measures are being successfully addressed in our new telehealth model.
(6) A remote behavioral health “warm hand-off” model is now in place for telehealth visits.
(7) Patient and staff satisfaction will be presented. Initial data show that patient satisfaction is high