Telehealth usage patterns among pediatric neurology patients during and after the COVID-19 pandemic in Washington state

The COVID-19 pandemic accelerated the adoption of telehealth across the United States. While telehealth usage during the pandemic has been described, evaluating utilization across different policy periods is necessary to understand which groups engage most with this care modality under select situational barriers. This study aimed to analyze telehealth usage by demographic groups in a pediatric neurology cohort, focusing on utilization patterns during and after the pandemic. A retrospective analysis was conducted of 35,700 visits among 18,053 unique pediatric neurology patients at Seattle Children’s Hospital across three phases of the pandemic (initial – 3/2020–5/2020, sustainment – 6/2020–3/2022, and maintenance – 4/2022–3/2023). Logistic regression models assessed the impact of demographic factors on telehealth utilization. Regression effect sizes were estimated for language, race/ethnicity, and insurance type. Telehealth utilization varied across demographic groups and geographic regions. Non-English speakers had lower telehealth usage during the sustainment and maintenance phases (OR 0.56; OR 0.50, respectively). Black patients had lower usage in the sustainment phase (OR 0.86). Patients with government insurance had decreased usage during all phases compared to those with commercial insurance (OR 0.91; OR 0.83). Patients residing farther from urban centers consistently had higher telehealth utilization across all phases. This study identified differences in telehealth utilization by language, community resources, race/ethnicity, insurance, and geographic location. Solutions to address these differences are proposed, such as loaner device programs and language concordant technical support. Telehealth remains especially important for rural communities, highlighting the need to preserve and enhance access, particularly through language support, to ensure equitable care delivery statewide.