Association of a School-Based, Asthma-Focused Telehealth Program With Emergency Department Visits Among Children Enrolled in South Carolina Medicaid

To determine if access to school-based telehealth for children in a medically underserved community impacted number of all-cause emergency department (ED) visits, overall and among children with asthma.

Children age 3–17 years who were enrolled in Medicaid residing in 5 counties in South Carolina from 2012–2017. Participants were part of a natural experiment, in which a school-based telehealth program was implemented from 2015–2017 in one county (Williamsburg) but was not implemented in four neighboring counties, which served as the control. The final sample included 23 198 children from Williamsburg and 213 164 children from surrounding counties contributing a total 2 443 405 child-months.

The authors used Medicaid claims data. The main exposure of interest was access to the telehealth program. The outcome was difference in rate of all-cause ED visits prior to (2012–2015) and after (2015–2017) implementation of the program in Williamsburg compared with the difference in rate in the four surrounding counties over the same time period. The authors adjusted for age, race/ethnicity, sex and fixed effects (to account for differences by county and temporal changes). Analysis was then performed in the subgroup of children with asthma.

Rate of all-cause ED visits was not different between the groups. However, among children with a diagnosis of asthma, access to school-based telehealth was associated with a statistically significant reduction in all-cause ED visits (a 21% relative decrease). This was only significant in the third year after implementation of the program. In the full sample, the program was associated were fewer all-cause ED visits among children age 8–12 and among white compared with African American children.

The authors conclude that there was a benefit of school-based telehealth for children with asthma from underserved areas. Benefits may extend to other chronic diseases and may be driven by improved monitoring and treatment modifications, adherence, involvement of trained nurses, and reimbursement through Medicaid. The program took 3 years to have a significant impact.

There are limited data on impacts of telehealth programs in pediatric patients, and the authors used a novel design to address this important question that is challenging to study. The study, performed in a medically underserved population, demonstrates that school-based telehealth initiatives have the potential to improve health outcomes in children. The coronavirus disease pandemic, which has broadly restricted access to pediatric care for both well-child care and chronic disease management, has highlighted the need for integrating telehealth-based care into pediatrics. This study demonstrates a potential benefit, although more information is needed to identify which subgroups stand to benefit the most and why, and to modify programs to extend benefits across age and race and ethnicity as well as to home-based telemedicine.