# Optimizing Pediatric Subspecialty Care Through Telemedicine and e-Consultations

> **NIH NIH K23** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2020 · $52,030

## Abstract

Over one quarter of children in the United States live with chronic health conditions. Many of these children
require care from pediatric subspecialist physicians. However, 24% of children in need of subspecialty care
have difficulty accessing this care due to geographic and socioeconomic barriers. Telemedicine is a novel
approach for overcoming these barriers by delivering pediatric subspecialty across a distance using two-way
audio-visual technology. Early data suggest that telemedicine has great potential to expand access and reduce
disparities in pediatric subspecialty care. Yet much about telemedicine is poorly understood, with few studies
examining how it is currently used or how to use it more effectively. Such data are important because uncritical
expansion of telemedicine poses potential harms as well as potential benefits, including the potential for
inappropriate use, unnecessary overuse, or exacerbated disparities if new technology is afforded to only a
subset of the population. A critical need exists to identify current determinants of telemedicine use, barriers to
use, and optimal strategies to ensure appropriate use by integrating subspecialty telemedicine into the patient-
centered medical home. The overall goal of this study is to develop actionable strategies to advance the
delivery of pediatric subspecialty care through telemedicine to overcome disparities and improve child health.
In Aim 1, we will determine patient, subspecialist, primary care, and system-level factors associated with the
use of telemedicine for ambulatory pediatric subspecialty care through analysis of a large, state-wide Medicaid
database. In Aim 2, we will identify physician-perceived barriers to use of telemedicine for ambulatory pediatric
subspecialty care through a national survey. In Aim 3, we will use data from prior aims along with clinician and
parent input to develop a generalist-subspecialist e-consultation platform to improve appropriate use of
telemedicine for ambulatory pediatric subspecialty care. Through these aims, we will significantly improve our
understanding of the role of telemedicine in improving access to care for children with chronic conditions,
setting the stage for future interventions to optimize outcomes through appropriate telemedicine use. With
guidance from committed mentors and strong institutional support, the PI will also receive the necessary
intensive mentorship, didactic education, and research experience to become an independent investigator,
supporting career development objectives in advanced statistical modelling, implementation science, and
clinical informatics. This work will provide essential preliminary data to support future grant applications to
examine the impact of telemedicine use in observational data and to perform a pilot randomized controlled trial
of the e-consultation platform developed herein. With these new skills and novel preliminary data, the PI will be
poised to lead large studies to examine and...

## Key facts

- **NIH application ID:** 9895472
- **Project number:** 5K23HD088642-04
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Kristin N Ray
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $52,030
- **Award type:** 5
- **Project period:** 2017-04-01 → 2020-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9895472

## Citation

> US National Institutes of Health, RePORTER application 9895472, Optimizing Pediatric Subspecialty Care Through Telemedicine and e-Consultations (5K23HD088642-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9895472. Licensed CC0.

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