ABSTRACT
Background: The COVID-19 pandemic has necessitated an unprecedented increase in the use of telemedicine, the distribution of healthcare services using communication technology which allows for physical separation of the patient and provider. In Pediatric Genetics, there has been a longstanding interest in implementing telemedicine-based care to increase access to diagnostic testing, patient counseling and medical management of rare inherited diseases. In response to COVID-19, the Division of Human Genetics at the Children’s Hospital of Philadelphia rapidly transitioned to telemedicine-based care. Objective/Aim:We sought to understand howthe use of telemedicine affected medical care for patients with suspected or confirmed genetic conditions. In addition to assessing the immediate impact of telemedicine on Pediatric Genetics care, we asked if this new care model could provide long-term benefit in increasing our effectiveness and efficiency, improving patient outcomes and reducing healthcare disparities. Methods:We initiated a quality improvement project to evaluate the utility of telemedicine pre-pandemic and during the pandemic. This included 3869 outpatient encounters in the Division of Human Genetics from March 1, 2020 to November 30, 2020 and 3228 outpatient encounters from the same time period in 2019. Visit types, diagnosis codes, patient demographics and laboratory procedure codes were pulled from Epic, and patient satisfaction was assessed using Press Ganey scores. This project was undertaken as a Quality Improvement Initiative and as such does not constitute human subjects research. Results: Of the encounters in 2020, 75% (n = 2895) were virtual, compared to 3% (n = 81) of the encounters in 2019. Using primarily telemedicine-based appointments in 2020, we saw nearly 20% more patients than were seen using primarily in-person appointments in the same time period in 2019. Genetic counselor-only appointments more than doubled, with 312 encounters (8% of all appointments) in 2020, and 149 encounters (5% of all appointments) in 2019. The distribution of visit types was similar in both time periods, with new patient appointments comprising 56% of appointments in 2020 compared to 53% in 2019, and follow-up appointments comprising 44% of appointments in 2020 compared to 47% in 2019. Press Ganey scores indicated improved rates of overall patient satisfaction (84.3% in 2020 vs. 80.1% in 2019) as well as satisfaction with access (76.0% in 2020 vs. 62.1% in 2019) and moving through the visit (67.7% in 2020 vs. 56.4% in 2019). Conclusion: The Division of Human Genetics at the Children’s Hospital of Philadelphia seamlessly transitioned to telemedicine in the midst of a global pandemic. Using telemedicine, there was increased patient access and patient satisfaction. Long-term use of telemedicine may result in increased access to care and improved efficiency in care delivery.
ABSTRACT
Introduction: The COVID-19 pandemic has caused significant disruption to normal day-to-day life, including physical, mental, and social health. The impact of COVID-19 on quality of life in youth with type 1 diabetes (T1D) is not known. Objectives: This study utilized the COVID-19 Exposure and Family Impact Survey (CEFIS) to examine COVID exposure/impact and quality of life in a pediatric T1D population over 6 months. Methods: Parents of youth with T1D (mean age 11.6±4 yrs, mean T1D duration 5.3±3.9yrs, 57.4% male) completed the CEFIS (score ranges: Exposure 0-25, Impact 0-4 with >2.5 indicating negative impact, and Distress 1-10). Parents and youth completed the PedsQL Diabetes Module 3.0, (higher scores indicate better quality of life). Measures were obtained at baseline (Sept to Nov 2020), 3 months (Dec 2020 to Feb 2021), and 6 months (Mar to May 2021). Changes in scores and associations between CEFIS and PedsQL scores were analyzed. Results: Survey scores indicated a relatively low COVID exposure at all time points (7.7, 7.9, and 8.0). Impact was unchanged throughout the study (2.7 at all times), however, it was above 2.5, indicating negative impact. Overall, distress was significantly lower at 6 months compared to baseline (4.8 to 4.4, p=0.045), yet parents also reported a significant decrease in total child quality of life at 6 months (p=0.021). Increasing CEFIS scores (Exposure, Impact, and Distress) were associated with decreasing PedsQL total scores for both parent proxy and child surveys (p<0.05 for each CEFIS scale) (Table). Conclusions: Despite relatively low COVID exposure, families of youth with T1D have been negatively impacted by the pandemic. Pediatric quality of life was significantly lower with increased COVID exposure, impact, and distress, highlighting the importance for health care providers to consider the psychosocial impact of the COVID pandemic on this population. Further research is needed to determine the effect on T1D management.