Analysis of Telemedicine Comprehensive Health Assessments for Children in Foster Care Performed During the COVID-19 Pandemic

Background: Study of telemedicine programs deployed during the COVD-19 emergency will inform optimal and equitable use post-pandemic. Given unique health care needs and barriers experienced by children in foster care, studies of telemedicine dedicated to this population are needed. Our objectives were to describe outcomes of a telemedicine program serving children in foster care during the pandemic and to compare outcomes between telemedicine and in-person comprehensive health assessments (CHA).

Methods: An evaluation model clinic for children in foster care conducted CHA via telemedicine when in-person visits were restricted during the pandemic. Our institution conducts telemedicine through our patient portal app. Consent is required during the telemedicine login process, and advocacy efforts led to our county’s commissioner of child protective services consenting to telemedicine visits for children in care during the pandemic. Outcomes of telemedicine referrals were tracked in REDCap. Questions from the validated Telehealth Usability Questionnaire (TUQ) were completed by physicians who rated their ability to: hear patients, see patients and express themselves after each telemedicine visit. Prevalence of laboratory testing completion, prescriptions, and referrals (medical, behavioral, and developmental health) among children undergoing telemedicine CHA was compared to children undergoing in-person CHA at the same clinic the year prior. Descriptive statistics, Chi-squared and Fischer-exact tests were used.

Results: Of 91 referrals reviewed, 83 (91%) resulted in completed telemedicine CHA, 3 never logged in to scheduled visit(s), 3 had prohibitive technology barriers, and 2 were determined to require in-person CHA. Mean age of telemedicine patients was 9.2 years (SD 5.7) (table 1). Seven patients missed 9 appointments for an attendance rate of 90% (83/92). Mean duration of visits was 66 minutes (SD 24.5). Response rate for TUQ (81 sent to attendings, 58 to fellows) was 98% and figure 1 displays results. Table 1 details medical recommendations following telemedicine CHA compared to in-person CHA.

Conclusion: Telemedicine successfully enabled healthcare delivery to children in foster care while in-person visits were restricted. Over 2/3 of telemedicine patients received referrals and over 1/4 received prescriptions. High show rates suggest telemedicine was accessible to most families.

Results can inform post-pandemic use of telemedicine. Low physician ratings of being able to see patients as well as if in person, as well as lower rates of referrals for vision services and lab work highlight essential in-person components of CHA. Once components of CHA such as detailed skin exam, vision screen and lab work are completed in-person, telemedicine could be used for follow-up visits. Need for specialty services was high, and in cases where access is limited by transportation barriers, in-person components of care could be completed by local providers coupled with care coordination for specialized care via telemedicine. Ongoing advocacy to overcome unique consent and potential technology barriers is needed.