Program Evaluation: A Primary Care Clinic’s Transition During COVID-19

Background The COVID-19 pandemic has shifted the nature of medical care in pediatric primary care Tomitigate transmission SARS-COV-2 and to preserve the supply of personal protective equipment, CDCguidelines advise limiting non-essential medical visits However, administering vaccinations, facilitatingdevelopmental screening, managing acute medical illness, and identifying and treating mental illness remainof paramount importance to the health of children Objectives This program evaluation explores how a singleprivate primary care clinic shifted over the course of a few weeks from standard on-site ambulatory care to apredominantly telemedicine-based format, with specic protocols for in-person sick visits and well child care(WCC) for infants and toddlers Methods A descriptive survey was undertaken of practice changes occurring ina single, private pediatric primary care clinic during the COVID-19 pandemic Regulatory changes, paymentpolicy updates, and ethical considerations guided decisions about the utilization of telehealth Infants sixmonths and under continued to undergo routine on-site WCC Families of children 9-18 months old were offered a choice of either hybrid telemedicine interviews followed by open-air exam and vaccinationconducted in the clinic parking lot, versus routine on-site WCC Families of children 2 years and older wereoffered telehealth WCC with on-site exam and vaccination scheduled for 3-4 months ahead All sick visits wereinitiated via telehealth, with open-air exam and testing performed if deemed indicated by the provider Weeklyvisit number, percentage of well child checks, percentage of acute sick visits, and percentage of mental healthvisits were assessed through the clinic's electronic medical record Results Advanced Pediatrics (AP) is aprivate, suburban pediatric primary care clinic AP serves approximately 8,000 patients from birth through age22 years and averages 2000 patient visits per month In the month prior to the COVID-19 pandemic, >99% ofvisits were on-site;28% percent of visits were for WCC, 65% percent for acute illness, and 7% percent formental health In the month following the implementation of the COVID-19 telemedicine strategy, the totalnumber of visits decreased by 45% Telemedicine comprised 82% of visits WCC accounted 37% of visits, acutemedical care 55%, and mental health 8% of visits At the time of submission, the number and proportion ofvisits that were WCC as compared to acute medical care visits appeared to be increasing each week Conclusion Utilizing existing technologies and adapting to rapid changes in regulatory and billing policies, asingle private practice shifted the provision of pediatric care to a predominantly telemedicine based format,with specic protocols for in-person visits for well and sick children By sharing lessons learned from thisexperience, pediatricians may craft universal procedures that can be mobilized in case of future interruptionsto the standard model of medical care Impact of COVID Plan on the Location of Care In the month prior to the COVID-19 pandemic, >99% of visits were on-site;in the month following the implementation of the COVID-19 telemedicine strategy, 82% of visits were conducted via telemedicine, with only 28% of visits occurring on-site Impact of COVID Plan on the Distribution of Visits by Visit Type Despite a shift to telemedicine, the proportionsof well child care, acute sick visits, and mental-health related visits did not differ greatly in the pre- and post-COVID Plan periods