Urban Telemedicine Enables Equity in Access to Acute Illness Care

Telemed J E Health. 2017 Feb;23(2):105-112. doi: 10.1089/tmj.2016.0098. Epub 2016 Jul 6.


Background: Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall.

Introduction: We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation.

Materials and methods: Health-e-Access Telemedicine was initiated in stepwise manner over 187 study-months among 74 access sites (childcare, schools, community centers), beginning in month 105. Children dwelled in inner city, rest-of-city Rochester, NY, or in surrounding suburbs. Rate of total acute care visits (office, ED, telemedicine) was measured as visits per 100 child-years. Observed utilization rates were adjusted in multivariate analysis for age, sex, insurance type, and season of year.

Results: When both suburban and inner-city children lacked telemedicine access, overall acute illness visits were 75% greater among suburban than inner-city children (suburban:inner-city rate ratio 1.75, p < 0.0001). After telemedicine became available to inner-city children, their overall acute visits approximated those of suburban children (suburban:inner-city rate ratio 0.80, p = 0.07), whereas acute visits among suburban children remained at least (worst-case comparison) 56% greater than inner-city children without telemedicine (rate ratio 1.56, p < 0.0001).

Discussion: At baseline, overall acute illness utilization of suburban children exceeded that of inner-city children. Overall utilization for inner-city children increased with telemedicine to that of suburban children at baseline. Without telemedicine, however, inner-city use remained substantially less than for suburban counterparts.

Conclusions: Health-e-Access Telemedicine redressed socioeconomic disparities in acute care access in the Rochester area, thus contributing to a more equitable community.

Keywords: equity; healthcare access; information management; pediatrics; telehealth; telemedicine.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Age Factors
  • Child Care / organization & administration
  • Child Health Services / statistics & numerical data*
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Services Accessibility
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Office Visits / statistics & numerical data
  • Poverty
  • Schools / organization & administration
  • Seasons
  • Sex Factors
  • Socioeconomic Factors
  • Suburban Population / statistics & numerical data*
  • Telemedicine / statistics & numerical data*
  • Urban Population / statistics & numerical data*