Telehealth triage in pediatric rheumatology: a diagnostically accurate tool to improve access to care
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Laura Aisenberg
,
Irit R. Rasooly
,
Pamela F. Weiss
,
Jon Burnham
und
Anna Costello
Abstract
Objectives
During the SARS-CoV-2 pandemic, new patient evaluations in pediatric rheumatology were performed using telehealth. Given the pediatric rheumatology workforce shortage, telehealth may be a way to efficiently triage referrals. The objective was to assess the utility of telehealth visits as a diagnostic tool to accurately assess the need for in-person evaluation.
Methods
This was a retrospective cohort study of patients evaluated by telehealth for a new patient visit from March 1 to June 30, 2020 at a tertiary center. Electronic health record documentation from subsequent rheumatology, specialty, and primary care encounters over the subsequent 4 years were reviewed. The primary outcome was diagnostic concordance, defined as consistency in the documented diagnostic reasoning, between the initial telehealth video visit and in-person follow-up visits.
Results
During the study period, there were 111 telehealth visits, 80 (72 %) of which had follow-up data. 55/80 had in-person rheumatology evaluations. Only 9 % patients had discordant diagnoses, all of whom had initial concern for inflammatory arthritis during the telehealth visit but a diagnosis of a non-inflammatory condition after in-person evaluation. Nine patients with a significant rheumatic disease were identified via telehealth. There were no unplanned ED visits or hospital admissions following telehealth visits. 33 % of patients were found to not warrant rheumatologic follow-up after the telehealth visit.
Conclusions
For pediatric rheumatology new patient evaluations, diagnostic accuracy via telehealth evaluation was high. Providers triaged patients with chronic rheumatologic conditions for in-person evaluations and were able to accurately identify benign conditions that did not require in-person follow-up.
Award Identifier / Grant number: K24
Funding source: Childhood Arthritis and Rheumatology Research Alliance
Award Identifier / Grant number: GRT-00004219
Funding source: AcademyHealth
Award Identifier / Grant number: GRT-00004483
Funding source: Arthritis Foundation
Award Identifier / Grant number: GRT-00004219
Funding source: Gordon and Betty Moore Foundation
Award Identifier / Grant number: GRT-00004483
Funding source: Agency for Healthcare Research and Quality
Award Identifier / Grant number: K08
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Research ethics: The study was conducted in accordance with the Declaration of Helsinki and was deemed exempt by the Children’s Hospital of Philadelphia Institutional Review Board (IRB-22-020676) on March 17, 2023 with the need for written informed consent waived.
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Informed consent: Not applicable.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Childhood Arthritis and Rheumatology Research Alliance/Arthritis Foundation (AC), AcademyHealth/the Betty and Gordon Moore Foundation (AC), AHRQ K08 (IRR), and NIH NIAMS K24 (PFW).
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Data availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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