Rapid Adoption of Telehealth Due to the COVID-19 Pandemic in A Large Urban Federally Qualified Health Center – Adapting the Pediatric Model to Care for Patients in Need

Background/Program Goals: The COVID-19 pandemic has led to a signicant decline in the numbers ofambulatory healthcare visits in the US, with pediatricians seeing 62% fewer patients during the rst week inApril than the rst week in March (Adult/OB outpatient visits have declined 45-50% ) Nationwide, during April2020, it is estimated that approximately 30% of ambulatory visits were carried out via telehealth Inner-citychildren in Chicago live in families that are disproportionately impacted by the COVID-19 pandemic OurChicago-land Federally Qualied Health Center (FQHC), which serves over 80,000 patients and at baselineprovided over 6,000 weekly in-person visits (patient panel is 47% children/adolescents, > 90% low income, 71%Hispanic/Latino) is markedly changing our care model, including a rapid shift to telehealth, in order tomaintain needed services for our patients The services provided by our FQHC pediatricians are also changingin order to meet our FQHC's patient's needs during this time Evaluation: review of PDSA cycles, qualitative/quantitative feedback from staff and patients/families, clinical quality data Discussion: (1) Frommid-March to mid-April 2020, visit volume at our FQHC initially fell by 75% but now is approximately 85% ofpre-COVID volume No medical and only a few behavioral health visits were by telehealth prior to March Wewill describe how we used a plan-do-study-act (PDSA) approach to change our care delivery model so that 75%of visits are now being delivered partially or completely via telehealth (2) In the same period, our FQHC saw ashift in the age of patients accessing our call center with 2/3 of the requests for healthcare now from patientsover age 18 (before COVID-19, over half of all calls were for patients under age 18) Pediatricians at our FQHCnow provide telehealth visits for patients through age 25 (with structured support in place from ouradult/family medicine colleagues and informal continuing medical education on young adult topics as needed)in order to meet current patient demand (3) Targeted outreach to patients under age 2 for vaccinations, andfor all ages with special health care needs or chronic illness (including asthma), has been a successfulapproach to maintaining ambulatory/telehealth visit volume for pediatricians (4) All telehealth visits include aone-question social needs assessment screener Approximately 40% of patients screen positive and are beinglinked with appropriate resources in their communities by FQHC staff (5) As an FQHC, we report qualitymetrics including pediatric immunization rates, nutrition/activity counseling and adolescent depressionscreening These measures are being successfully addressed in our new telehealth model (6) A remotebehavioral health “warm hand-off” model is now in place for telehealth visits (7) Patient and staff satisfactionwill be presented Initial data show that patient satisfaction is high