In a recently released issue of Pediatrics, Dr. John Chuo and colleagues share strategies for evaluating telehealth encounters (10.1542/peds.2020-1781). The authors address a key question: how can we meaningfully evaluate telehealth, which has become a staple of pediatric healthcare during the pandemic? The article succinctly shares the work of the AAP Section on Telehealth’s Supporting Pediatric Research in Outcomes and Utilization of Telehealth (SPROUT) group, and brings logic and sense to a timely and challenging question. Incorporating the telehealth outcomes guides of the World Health Organization, the National Quality Forum, and the Agency for Health Research and Quality, the authors propose 4 domains: (1) Health Outcomes (did individual measures of health and disease improve), (2) Health Delivery (equity, safety and cost of access), Patient Experience factors, and Program Implementation and Key Performance Indicators (systems measures). The authors also identify 4 commonsense stakeholder groups for whom these measures will be important: patients, providers, health systems and payers. Good information awaits you in this unique article.
As a provider, my own telehealth experiences probably mirror those of many others. In March, our practice plunged into virtual visits with multiple goals, all the way from simply “touching base” with families to identify social needs, to medical “check-ins” for children with chronic illness, to conducting minor illness visits virtually. The experiences ranged from the hilarious to the humbling. I tried to visualize a rash on the back of a speedy toddler dashing around a dimly lit room, with his parent chasing him with a moving cell phone view just out of focus. I listened to a teen’s father explain to me that he and his son were “fine,” because they had 2 days of food in the home, so please prioritize assisting others who have greater needs (we found him help). I talked with a mother who picked up the virtual visit while shopping at Target, and paused in the aisle so her 10 year old could explain his headaches to me. I am confident others have also had this wide range of virtual visits, some very helpful and some likely not, though the unifying theme was deep gratitude from families for a phone call or virtual visit, regardless of content or timing. Simply connecting made all the difference.
The coherent and thoughtful framework for telehealth evaluation proposed by Dr. Chuo and colleagues is a great step forward to understanding the healthcare and health system impacts of our telehealth work. Finding a way to measure the wealth of our diverse efforts and experiences will benefit all stakeholders, hopefully most of all, our patients and families.
