46.2 Transition From an In-Person to a Remote Pediatric Collaborative Care Model During COVID-19: Effect on Program Efficiency and Outcomes

Abstract

The COVID-19 pandemic accelerated the transition of many ambulatory services to a remote model, including integrated pediatric behavioral health. And while there exists a body of evidence around the effectiveness of pediatric integrated care, there is a dearth of research on delivering these services virtually. Beginning in March of 2020, the Northwell Pediatric Collaborative Care Program transitioned to an entirely remote model, with services delivered either via phone or telehealth. This poster will examine the effect of these changes on key measures of program efficiency and effectiveness. Looking at a cohort of care managers present before and after the model change, we compared a series of process and outcome measures during the same 6-month period (July to December) of 2019 and 2020. The core services delivered included assessment, brief therapy, collaborative medication management, and care coordination. The specific data points examined were the number of unique monthly patient contacts, the total number of patient contacts, the types of contacts provided, and the depression and anxiety improvement rates on the Patient Health Questionnaire-9A (PHQ-9A) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. The number of unique monthly patient contacts rose by 72% (n = 621 vs n = 1071), while the total number of contacts rose by 86% (n = 859 vs n = 1601). Eighty-eight percent of care management contacts were delivered in person and 12% by phone in 2019, whereas 70% of contacts were by phone and 30% by telehealth in 2020. The depression improvement rate increased from 53% to 64%, while the anxiety improvement rate decreased from 63% to 57%. These results suggest that a remote model may be a viable option for some patients receiving integrated pediatric services. The number of patients served and number of contacts increased significantly, suggesting potential for greater operational efficiency, while the high proportion of phone contacts in 2020 may reflect initial challenges with telehealth connectivity and patient preference. Improvement in adolescent depression outcomes suggest that clinical effectiveness was maintained, while anxious patients seemed to have fared less well with this approach. Further examination of clinical outcomes will be necessary to best understand what works for whom and how to best use remote integrated care offerings going forward.