1048 The impact of telehealth: adherence to high-risk maternity care during the SARS-CoV-2 Pandemic

Kouba, Insaf; Wei, Lili S.; Bennett, Terri-Ann M.; Aglialoro, George; Walker, Aisha A.; Friedman, Steven; Mehta-Lee, Shilpi S.

Objective: In March of 2020, at the outset of the SARS-CoV-2 pandemic in New York City (NYC) the Maternal Fetal Medicine (MFM) clinic at a federally qualified health clinic (FQHC), transitioned to the use of telehealth in order to implement social-distancing. We aimed to determine the impact of telehealth availability on patient access and adherence to MFM care at a FQHC during and after the SARS-CoV-2 pandemic. Study Design: This is a retrospective, quality improvement project comparing non-adherence to scheduled visits over 3 timeframes: 1. "Pre-COVID" (11/1/2019-2/28/2020) 2. "COVID" (4/1-7/31/2020) - virtual telehealth fully implemented 3. "Post-COVID" (8/1-9/15/2020) - after NYC surge of SARS-Cov-2 with conversion back to in-person visits. All scheduled encounters in the MFM FQHC clinic were included. Non-adherence was defined as encounters cancelled prior to appointment time or a "no-show." Chi-square and logistic regression (SAS v9.4;Carey, NC) were used to compare differences between groups with p<0.05 defined as significant. Result(s): A total of 511 encounters were evaluated. Encounter completion rates differed among groups (p <0.001). (Table). During COVID, when telehealth was utilized, non-adherence rates were significantly lower than in both the pre-COVID and post-COVID timeframes (when telehealth was no longer utilized). (Figure) Conclusion(s): Adherence of women to telehealth encounters for MFM care was higher than pre-COVID and post-COVID in-person encounters. Telehealth expands access to MFM care in an FQHC and may improve access in the future as women face challenges managing the need for in-person visits with the demands of childcare and attempted infection risk-avoidance. This may serve as a model for increasing future access and adherence to care. Further work is needed to understand the impact of telehealth on maternal and neonatal outcomes. [Formula presented] [Formula presented]Copyright © 2020