PC3049: Patient and Provider Characteristics and Decrease in Pediatric Well-child Visits During the COVID-19 Pandemic

Background: While the COVID-19 pandemic created an opportunity for widespread telehealth adoption, the degree to which in-person visits for Early and Periodic Screening and Diagnostic Treatment (EPSDT) well-child care was impacted is thought to be significant. However, little is known about the degree to which patient and provider characteristics impacted the frequency of in-person EPSDT visits during the pandemic.

Methods: Comprehensive data on ambulatory pediatric visits in a large academic hospital system in Washington state were obtained from merged medical records, billing, and telehealth databases. From January 2019 to March 2021, pediatric well-child visits were identified using billing codes (Z00.129). The data were analyzed using descriptive statistics to identify: 1) Frequency of EPSDT in-person visits at various age ranges before and during the early phases of the COVID-19 pandemic; 2) Patient demographics including age, gender, distance from clinic, zip code, and race/ethnicity; and 3) Provider demographics including specialty, qualifications, years of experience.

Results: Data was available on 51,418 ambulatory well-child visits by pediatric and family medicine providers in patients aged < 21 years. Female and male patients were equally represented (1.03:1). During the COVID-19 pandemic (March 2020-March 2021), there was a decline in the number of EPSDT visits in all age groups compared to pre-pandemic levels. The decline was more prominent for patients aged 4-6 years (Figure 1), patients residing at a greater distance from the clinics (-69% for distances >20 miles) (Figure 2), and in family medicine visits (-67% family medicine vs. -40% pediatrics). The number of well-child visits peaked in the summer (as seen in July-Sept 2019), but this peak was blunted in July-Sept 2020 (-22% family medicine vs. -5% pediatrics). Over the study period, physicians with < 5 years of experience recorded an increase of 215% in their patient visits, while more experienced physicians’ patient visits declined by 22%.

Conclusion: During the COVID-19 pandemic, there was a decline in the volume of in-person well-child visits, particularly with family medicine providers and in patients aged 4-6 years and those living at further distances from the clinics. However, physicians with less than 5 years of experience saw large gains in visit volumes compared to physicians with more experience whose volumes declined. More studies are needed to understand the association of provider and patient characteristics with the decline in inpatient visits during the pandemic and the potential for telehealth to support the continuity of pediatric care.