ABSTRACT
Introduction: One of the major impacts of the COVID-19 pandemic on healthcare has been the increased utilization of technology. When face-to-face visits pose a public health concern, providers across various specialties have become increasingly reliant on virtual visits, phone calls, and MyChart messages to provide care. With this shift in healthcare delivery, an analysis of the impact on healthcare is needed. The objective of this study is to determine how increasing telemedicine utilization affects the care provided to pediatric gastroenterology patients with a focus on inpatient acuity and the care methods prior to admission. Methods: A retrospective chart review of patients admitted under the care of the pediatric gastroenterology team at Doernbecher Children's Hospital was performed for April - June 2019, 2020, and 2021. Length of stay and requirement of intensive care (PICU) admission were used as measures of inpatient acuity with secondary outcomes being the number of clinic visits, telephone calls, and MyChart messages in the 3 months preceding admission. Descriptive statistics were used for demographic data and T-tests were used for continuous variables and Fischer's Exact test for binary variables. Results: The average length of stay per patient was 4.14 days in 2019 compared to 3.88 days in 2021, which was not significantly different (Table 1). There was no significant difference in the percentage of patients admitted to the PICU. In 2021, 70.6% of admitted patients were seen in the GI clinic in the 3 months prior to admission with an average of 2.67 visits per patient compared to 42.9% in 2019 (p-value 0.04) with an average of 1.33 visits per patient. 67.6% of patients called the provider in the 3 months prior to admission in 2021 with an average of 3.57 calls per patients compared to 35.7% in 2019 (p-value 0.02) with an average of 3.8 calls per patient. In 2021, 50% of patients used MyChart with an average of 6.53 messages, compared to 31.4% with an average of 2.67 messages in 2019 (p-value 0.03). Discussion: With the transition to the telemedicine platform in response to the COVID-19 pandemic, a potential concern was that providers would not be able to provide as effective of medical care. Thereby, patients might end up being sicker at the time of hospital admission. Notably, inpatient acuity as measured by length of stay or PICU admissions did not significantly change between 2019, 2020, and 2021. This observation suggests that despite potential limitations of the telemedicine platform, such as communication challenges or an in ability to conduct a live physical exam, patients and providers have been able to adjust and effectively share their medical concerns. Since the introduction of the telemedicine platform, patient healthcare seeking behaviors have changed as there have been a significant increase percentage of admitted patients utilizing virtual visits, telephone calls, and MyChart messages prior to admission. In addition, for patients using these methods of communication, there was a noticeable increase in the frequency of use of both virtual visits and MyChart messages, suggesting that patients may becoming more comfortable and potentially reliant on these communication methods. As this increase in utilization has not decreased length of hospitalization, it is possible that telemedicine has lowered the barrier to contacting providers, thus changing patient healthcare access behaviors. Limitations to this study include small sample size and the generalizability of this study as this is a single center study. Conclusion: The COVID-19 pandemic has forced providers to shift how they deliver care, with increased reliance on remote methods such as virtual visits, phone calls, and MyChart messages. We expected that limitations to in person care would mean that pediatric GI patients would be coming to the hospital sicker than before the pandemic. What was found instead was that adaptations were made to provide care virtually with an increase in non-in-person clinical contact while there was no change in length of inpatient stay. Future analysis will focus on longer term data and seek to determine if there are any differences in acuity based on diagnosis.