Evaluating Telehealth Implementation in the Context of Pediatric Chronic Pain Treatment during COVID-19.

Patricia A Richardson,Laura E Simons,Delana M Parker,Elliot J Krane,Kathryn A Birnie,Natoshia R Cunningham,Rashmi P Bhandari,Krystal Chavez

doi:10.3390/children8090764

Abstract

Telehealth has emerged as a promising healthcare delivery modality due to its ability to ameliorate traditional access-level barriers to treatment. In response to the onset of the novel coronavirus (COVID-19) pandemic, multidisciplinary pain clinics either rapidly built telehealth infrastructure from the ground up or ramped up existing services. As the use of telehealth increases, it is critical to develop data collection frameworks that guide implementation. This applied review provides a theoretically-based approach to capitalize on existing data sources and collect novel data to inform virtually delivered care in the context of pediatric pain care. Reviewed multisource data are (1) healthcare administrative data; (2) electronic chart review; (3) clinical health registries; and (4) stakeholder feedback. Preliminary telehealth data from an interdisciplinary pediatric chronic pain management clinic (PPMC) serving youth ages 8–17 years are presented to illustrate how relevant implementation outcomes can be extracted from multisource data. Multiple implementation outcomes were assessed, including telehealth adoption rates, patient clinical symptoms, and mixed-method patient-report telehealth satisfaction. This manuscript provides an applied roadmap to leverage existing data sources and incorporate stakeholder feedback to guide the implementation of telehealth in pediatric chronic pain settings through and beyond COVID-19. Strengths and limitations of the modeled data collection approach are discussed within the broader context of implementation science.

Highlights

In the early weeks of the COVID-19 pandemic, virtually-delivered care transitioned from being an innovative service delivery method to an essential healthcare platform
Analyses were primarily descriptive in nature
Within a span of weeks following the onset of COVID-19, virtually-delivered care shifted from being a promising service delivery method to an essential medium for providers to interface with patients

Summary

Introduction

In the early weeks of the COVID-19 pandemic, virtually-delivered care transitioned from being an innovative service delivery method to an essential healthcare platform. The expansion of telehealth was further supported by state and federal policy changes, including the Medicaid telehealth expansion, that lifted telehealth restrictions and established parity in reimbursement rates for virtual vs in-person care Assuming these policy changes persist, it is likely that standards of healthcare, including chronic pain treatment, will incorporate virtual intervention in the long term [3,4]. The goal of this applied review is to provide a resourceful and theoretically informed perspective on how to assess telehealth implementation by leveraging existing data sources and collecting stakeholder feedback. A case example of telehealth implementation from a multidisciplinary pediatric chronic pain clinic is presented and discussed as it relates to the broader implementation science literature

Methods

Results

Discussion

Conclusion