(353) Risk Factors Associated with Meeting the Standard of Care and Use of Telehealth in 2020 among Persons with Cystic Fibrosis in the United States

Background: The COVID-19 pandemic led to a dramatic decrease in clinic visits for essential health care needs for individuals with CF. However, the decline of in-person visits was accompanied by a rapid pivot by many CF care centers to provide telehealth services, similar to the U.S. health care system as a whole. In the absence of in-person visits, we hypothesized that individuals with CF who utilized telehealth services would be more likely to meet standard of care as defined by CFF guidelines than individuals who did not utilize or did not have access to telehealth. We also hypothesized that telehealth utilization or access would be lower among particular demographic groups based on disparities seen in non-CF telehealth studies.

Methods: For this study we used 2019-2020 data from the US CFF Patient Registry to describe patterns of telehealth utilization and to evaluate for associations between patient-level characteristics and use of telehealth in 2020 to achieve the standard of care. We quantified the extent to which persons with CF received the recommended components of the care model, comparing 2019 and 2020. A risk factor analysis was implemented to identify patient characteristics associated with attaining the standard of care and use of any telehealth in 2020 using multivariable logistic regression.

Results: A total of 28,132 CFFPR participants were included in the study. The proportion of individuals meeting the individual standards of CF care was lower in 2020 than 2019 for every indicator, and lower in adults compared to children. In 2020, Telehealth use was high among CFFPR participants, with 71% of children and 73% of adults reported ≥1 telehealth encounter. In adults, demographic, socio-economic and CF-related disease covariates were significantly associated with both achieving the overall standard of care and use of telehealth. In the pediatric population, Black race, Hispanic ethnicity, and markers of lower socio-economic status were associated with a lower odds of telehealth use. In all analyses, having received the standard of care in 2019 was associated with a higher odds of both reported telehealth use (OR: 1.28 (95% CI: 1.16, 1.41) among children) and achieving the recommended elements of the CF care model in 2020 (OR: 2.36 (95% CI: 2.11, 2.64) among children and OR: 2.61 (95% CI: 2.19, 3.12) among adults).

Conclusions: We observed that fewer individuals with CF met standards of care in the United States in 2020 compared to 2019 likely owing to pandemic-related effects. However, the use of telehealth services aided with improved adherence to some standards of care such as ≥4 encounters of any type, mental health screening, and annual ancillary consultations, but not 4 pulmonary function tests or bacterial cultures annually. The analysis suggests that there are disparities in access to telehealth services. Adults or children who were Black or Hispanic, or whose self/parents had lower levels of education had lower odds of telehealth use. Overall, CF care centers in the United States have proven remarkably adept in pivoting care models during the pandemic and some aspects of these models are important to be retained in a post-pandemic era.

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