Improving Access to Healthcare Through Telemedicine in an Underserved Asthma Population During the COVID-19 Pandemic

Purpose/Objectives: Our pediatric pulmonology clinic caters to an underserved community (primarily African-American and non-english speaking Hispanic patients). Barriers such as transportation, poor literacy and language contribute to a baseline median “no-show” rate of 33% (January 2019 to March 2020). During the COVID-19 pandemic families missed or cancelled in-person visits for fear of contracting the virus during visits. Despite improved access via telemedicine families continued to miss scheduled appointments. Our quality improvement project aimed to reduce the median “no-show” rate from 33% to 20% over 6 months through expansion of telemedicine visits and patient technical support.

Design/Methods: A team of physicians, front-desk staff and nurses educated families on telemedicine. We identified and addressed barriers to activating patient portal accounts, logging in during visits, and offered telemedicine appointments in lieu of in-person visits. We tracked monthly data.

Results: PDSA 1: We educated and enrolled patients on a patient portal with an inbuilt telemedicine module. Portal activation increased from 20% in April 2020 to 85% by December 2020. Simultaneously, we increased the number of telemedicine appointments from a baseline of 0% in February of 2020 to more than 75% by December 2020.

PDSA 2: We recognized that patients were experiencing technical and language issues with our patient portal. We began providing real-time troubleshooting when patients could not log-in for telemedicine visits.

PDSA 3: Due to the significant time spent during visits troubleshooting with patients, front-desk staff proactively reached out prior to visits to help patients log in. This proactive approach led to a sustained reduction in the no-show rate of 20% and lower.

PDSA 4: When patients missed in-person visits, we offered to convert the visit to a telemedicine visit enabling more consistent patient access to healthcare.

Conclusion/Discussion: We reduced the overall no-show rate from a baseline of 33% to 18%. Telemedicine offers a great alternative to in-person visits for chronic disease management.