O2172: Evaluation of the First Several Years of Pediatric Virtual Urgent Care at a Large Academic Medical Center

Background: Telehealth is a rapidly growing field, and its use was accelerated across stages of the COVID-19 pandemic. Telehealth is increasingly used for acute care visits through virtual urgent care. Telehealth, and such virtual urgent care visits, has the potential to increase access to care and reduce health disparities. We sought to characterize pediatric virtual urgent care use and subsequent 48-hour in-person returns.

Methods: This is a retrospective analysis of all patients < 18 years of age who presented to virtual urgent care at a large, single-center pediatric hospital from January 2020 to February 2023. All such encounters were included. To characterize the population, our multidisciplinary study team assessed sociodemographic characteristics including race, ethnicity, patient age, insurance status, and neighborhood deprivation index, calculated from census tract-level socioeconomic measures linked to a child’s geocoded address (index range 0-1, higher indicates more deprivation). All such data were obtained at the time of the virtual urgent care visit and extracted from the electronic health record. We also captured the number of 48-hour in-person acute care return visits after a virtual urgent care visit as well as the intent for follow up. Return was defined as presentation to in-person urgent care or emergency department within 48 hours of telehealth visit. Intent for immediate follow up was defined as documentation of recommended follow-up with any in-person provider within 48-hours. A remote exam device was distributed to a sample of patients at the end of the study period and utilization of the device during a telehealth visit was captured. Descriptive statistics were used to characterize utilization patterns.

Results: A total of 12,215 virtual urgent care visits took place during the study period. Patients were 11.8% Black, 91% non-Hispanic, and 49% female (Table 1). The most common chief complaint was Rash or Skin Problem (17%). The average neighborhood deprivation index was 0.283 (+/- 0.115), indicative of slightly lower socioeconomic deprivation in the neighborhoods where children with a virtual urgent care visit lived than Cincinnati overall. A total of 71% of virtual urgent care patients were given recommendations by the provider for in-person follow-up (i.e., primary care physician, urgent care, or emergency department). A total of 10% of patients had in-person acute care re-utilization within 48-hours of the telehealth visits. 2.9% of patients re-utilized care without indication by the provider to seek immediate in-person care. This was compared to 2.7% of patient 48-hour returns after in-person urgent care visits.

Conclusion: Acute telehealth visits may increase access to care by offering an appropriate alternative to in-person utilization. A low percentage of patients in this study returned to in-person acute care following a telehealth visit. This study helps to facilitate evaluation of implementation and utilization of pediatric telehealth.