Bridging the Divide: Unintended Consequences of the Shift to Home-Based Telemedicine

Abstract

ObjectiveTo evaluate the impact on healthcare access of the change in telemedicine delivery from a clinic-based model, in which patients connect with their healthcare provider from local telemedicine clinics, to a home-based model, in which patients independently connect from their homes. Study DesignIn this retrospective analysis, we compared relative uptake in telemedicine services in Period 1 (01/01/2019 – 03/15/2020, pre-pandemic, clinic-based model) versus Period 2 (03/16/2020 – 06/30/2022, home-based model) within a tertiary pediatric hospital system. Using multivariable logistic regression, we investigated the influence of telemedicine delivery model on patient sociodemographic characteristics of completed telemedicine visits. ResultsWe analyzed 400,539 patients with 1,406,961 completed outpatient encounters (52% White, 35% Black), of which 62,920 (4.5%) were telemedicine. In the clinic-based model (Period 1), underserved populations had greater likelihoods of accessing telemedicine: Hispanic ethnicity (odds ratio (OR)=1.41, p=0.028) vs reference group non-Hispanic, Medicaid (OR=2.62, p<0.001) vs private insurance, and low-income neighborhood (OR=3.40, p<0.001) vs medium-income. In aggregate, telemedicine utilization rapidly increased from Period 1 (1.5 encounters/day) to Period 2 (107.9 encounters/day). However, underserved populations saw less relative increase (Medicaid [OR=0.28, p<0.001], Hispanic [OR=0.53, p<0.001], low-income [OR=0.23, p<0.001]). ConclusionsWe observe that the clinic-based model offers more equitable access, while the home-based model offers more absolute access, suggesting that a hybrid model that offers both home-based and clinic-based services may result in more absolute and equitable access to telemedicine.