# Telemedicine Integrated into Pediatric Primary Care & Child Outcomes

> **NIH NIH R01** · CHILDREN'S HOSP OF PHILADELPHIA · 2022 · $729,078

## Abstract

During the summer of 2021, 80% of pediatricians reported using live audio-video telemedicine in the prior
month, up from 16% of pediatricians with telemedicine experience just four years before. Supported by
favorable federal and state policies begun to support physical distancing during the Coronavirus Disease 2019
(COVID-19) pandemic, the child health workforce now actively uses telemedicine to care for children, but lacks
evidence to guide best practices for telemedicine use in pediatric primary care. Our research team previously
found gaps in the quality of care delivered by commercial direct-to-consumer telemedicine for the most
common acute pediatric concerns (acute respiratory tract infections). We also demonstrated improvement in
management of common chronic conditions (e.g., asthma, attention-deficit/hyperactivity disorder) using
telemedicine in research settings. However, the child health community lacks data regarding the use of
telemedicine in evolving “real-world” primary care practices, including how telemedicine visits compare to in-
person visits for the same conditions and how telemedicine use impacts longitudinal outcomes and equity for
primary care patients. Additionally, we lack understanding of the structures and processes that support primary
care practices in using telemedicine in ways that optimally enhance child health and health equity. The
overarching goal of this proposal is to identify actionable strategies for promoting the use of telemedicine
within primary care in ways that improve child health and health equity, using data from primary care practices
from 2018-25. In Aim 1, we will compare visit-level quality of primary care visits for children delivered through
telemedicine vs. in-person using electronic health record data from over 1,000 practices including independent
practices, health system-affiliated practices, and community health centers. In Aim 2, we will compare child
health outcomes for children receiving care in primary care practices with higher vs. lower telemedicine use
through comparative interrupted time series analysis of metrics related to preventive, acute, and chronic care.
In both of these aims, we will examine the impact of telemedicine on health equity by assessing variation in the
effect of telemedicine by child and clinic characteristics. Finally, in Aim 3, we will identify the practice structures
and processes that promote or impede use of telemedicine in primary care in ways that improve child health
through a qualitative multiple-case study. Through this rigorous mixed-methods approach informed by the
Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model and a Structural Competency framework,
we will identify visit-level and child-level impact of telemedicine integration within primary care for children as
well as processes supporting health-promoting use of telemedicine. As a result, this examination of
telemedicine across preventive, acute, and chronic care activities o...

## Key facts

- **NIH application ID:** 10520465
- **Project number:** 1R01HD107153-01A1
- **Recipient organization:** CHILDREN'S HOSP OF PHILADELPHIA
- **Principal Investigator:** Alexander Gabriel Fiks
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $729,078
- **Award type:** 1
- **Project period:** 2022-09-15 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10520465

## Citation

> US National Institutes of Health, RePORTER application 10520465, Telemedicine Integrated into Pediatric Primary Care & Child Outcomes (1R01HD107153-01A1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10520465. Licensed CC0.

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