Introduction: There is limited knowledge of the effectiveness of telemedicine (TM) for management of pediatric urological conditions. With TM expansion, it is necessary to deliberately evaluate and establish its optimal role in pediatric urology. We sought to prospectively investigate clinician-determined efficacy of video visits (VVs) performed for pediatric urologic encounters at a single tertiary care children’s hospital. Methods: After entering the diagnosis and submitting billing using a TM modifier, clinicians were mandated to select whether the VV allowed for: complete case management (CCM), suboptimal, but adequate, case management (SCM); or incomplete case management (ICM) necessitating an in-person visit. These categorizations were compared according to patient pathology: internal organ pathology (IOP), functional urological pathology (FUP) or external organ pathology (EOP). The data were also stratified by patient-centered variables, including age, sex, race, and insurance type, to assess their impact on VV efficacy. Results: During the 4.5-month study period (5/18/22 - 9/29/22), 1,127 unique patients had a VV. Mean patient age was 8.4 years and 57.0% were male. Ninety-six percent, 3.3%, and 0.7% of VVs demonstrated CCM, SCM, and ICM, respectively. Approximately 88% of VVs were established patients and these TM patients were more likely to have CCM, compared to new patients (p < 0.001). TM patients with IOP and FUP were more likely to have CCM, than those with EOP (99.0% and 96.9% vs 87.1%, p<0.001). Older patients also had a higher likelihood of CCM (p=0.03). Meanwhile, Black, non-Hispanic patients were significantly less likely to have CCM (85.3%, p=0.02). Patient sex and insurance type did not impact the VV efficacy. Conclusions: Overall, TM is very effective for the management of pediatric urological patients. Our findings suggest that older established patients with IOP or FUP may be better suited for TM. Expanding on this data will allow for the development of best practice guidelines surrounding TM use in pediatric urology. To implement more inclusive strategies, further evaluation is necessary to understand why certain communities have less effective virtual care. SOURCE OF Funding: We have grant funding from our malpractice insurer, CRICO (Risk Management Foundation of the Harvard Medical Institutions), to investigate the safety, efficacy and equitability of telemedicine use in pediatric urology.
