Parent, physician, and therapist experience of in-person, hybrid, and all-virtual models of physiatry care for children with special healthcare needs

Abstract

ObjectiveThe purpose of this study was to compare three models of pediatric physiatry care (in-person, hybrid, and all-virtual) in terms of parent experience and physician- and therapist-reported quality of care. We hypothesized that the all-virtual model would have lower parent experience scores and lower quality scores compared with the other two models of care. MethodsWe designed a convergent parallel mixed methods study incorporating a cluster-randomized crossover design. Quantitative data included surveys of parents, physicians, and therapists after visits to 13 medical therapy units in Northern California between January 2020 and January 2022. Qualitative data were collected in six focus groups with parents, physicians, and therapists. ResultsA total of 2,455 visits were completed for 1,281 unique children during the study period, including 507 in-person visits, 246 hybrid visits, and 1,702 all-virtual visits. There were no differences in parent experience scores between the three models of care. Physicians and therapists rated all-virtual visits significantly lower in terms of quality of care, parent education, and physical exam, compared with the other two models of care, but qualitative results highlighted specific instances where all-virtual visits could be useful. ConclusionsOur findings suggest that parents, therapists, and physicians find a hybrid virtual model is an acceptable model of care that maintains the quality of care and facilitates parent education. All-virtual models may be appropriate for specific circumstances but are perceived as lower quality. Research exploring implementation of these models would be valuable for providing practical guidance in the future. What’s NewThis study is the first to compare three models of pediatric physiatry care (in-person, hybrid, all-virtual) from the perspectives of parents, physicians, and therapists. Qualitative data provides insights into the perceptions of these different stakeholders.