O1128: Family Language and Telehealth Uptake for Developmental Behavioral Pediatricbp assessments: A Dbpnet Study

Background:

Background: As a result of the COVID-19 pandemic, many developmental-behavioral pediatric (DBP) practices quickly adopted the use of telehealth for care delivery. However, telehealth access for families with a preferred language other than English (PLOE) is an equity concern.

Objectives: To compare rates of telehealth uptake by preferred family language among patients seen for DBP assessments during the COVID-19 pandemic, and to compare rates of completed and no-show visits, for telehealth and in-person appointments, including by preferred family language.

Methods: This descriptive chart review used electronic health record data at four academic DBP practices: 2 in the Northeast, 1 in the Midwest, and 1 in the Southwest. We included visits for patients up to 5 years of age, seen for new-patient appointments between April 2020 and April 2021. We compared rates of in-person and telehealth visits by preferred family language and visit outcome (completed or no-show) using chi-square and logistic regression. Monthly rates of telehealth visits as a percentage of total eligible visits for English-speaking and PLOE families were calculated, and important practice changes (e.g., availability of interpretation) considered. This study was approved or exempted by each site’s IRB.

Results: There were a total of 3241 visits throughout the 4/2020-4/2021 study period; 48.2% were conducted in-person and 51.8% by telemedicine. Families reported the following primary languages: 90.5% English, 6.2% Spanish, and 3.3% other language. Incomplete (no-show) visits accounted for 7.6% of total visits. The relative percentage of in-person versus telehealth visits varied significantly by site (p < 0.001), and by preferred family language (p < 0.001, see Table 1). English-speaking patients had 1.80 times the odds of being seen by telehealth compared to patients with PLOE. Statistically significant differences were not found for visit completion by visit type (in-person or telehealth) (p=0.79), even when accounting for preferred family language in multi-variable models (p=0.83). Figure 1 depicts the proportion of telemedicine visits over time for families with and without PLOE.

Conclusion: During the height of the pandemic, most English-speaking families were seen for new DBP evaluations by telehealth, but fewer families with PLOE were. The availability of interpretation in telehealth visits varied across sites and time. No-show rates did not vary by visit type but accounted for a low overall percentage of new visits; some in-person visits might have been converted to telehealth to avoid a no-show, which may underestimate the no-show rate for in-person visits. Limitations include that language may be incorrectly recorded in the electronic health record. The reasons behind low uptake of telehealth among families with PLOE should be further explored. Ongoing attention should be paid to promote language equity in access to DBP care overall, and to further understand issues of access to and acceptability of telehealth for families with PLOE.