N.C. Researchers to Study Telehealth Use for Children with Complex Conditions

A team at Wake Forest University School of Medicine plans to research the benefits of expanded use of telehealth by primary care physicians for children with complex chronic conditions and their caregivers.

With $4.4 million in funding from the Patient-Centered Outcomes Research Institute (PCORI), the project is a collaboration with Atrium Health Wake Forest Baptist Brenner Children's in Winston-Salem and Atrium Health Levine Children’s in Charlotte.

Telehealth experienced a rapid expansion with the COVID-19 pandemic, but questions remain about the most effective, evidence-based ways to incorporate telehealth as part of routine care, especially in chronic disease management, and how best to mitigate health disparities.

“In-person appointments can be incredibly challenging for families with medically fragile children,” said Savithri Nageswaran, M.B.B.S., professor of pediatrics at Wake Forest University School of Medicine and co-principal investigator of the study, in a statement. “Caregivers often must miss work to attend the many in-person appointments these children need, which can cause a financial strain. There’s also an enormous amount of planning ahead of time, given the medical complexity of the child, with feeding and medicines.”

Researchers will conduct a multicenter randomized control trial to test the benefits of a telehealth intervention called enhanced primary care (E-PRIME) at 36 primary care pediatric offices across North Carolina.

The research team plans to enroll 400 children who will be randomized to either the early (first six months of the study) or delayed implementation (later six months of the study) of E-PRIME. 

“Our primary objective is to improve the delivery of care to these children,” said Sabina Gesell, Ph.D., professor of social sciences at Wake Forest University School of Medicine, in a statement. Gesell is co-principal investigator of the study. “We would really like to understand health disparities in this population, and we expect to recruit at least 180 children from minority groups.”

The research team will evaluate the effectiveness of E-PRIME by measuring hospitalizations, emergency room visit rates and caregiver stress. All participants will be followed for one year.

“This study was selected for PCORI funding for its potential to answer the need for real-world evidence about how best to incorporate telehealth into the primary care of people with multiple chronic conditions and how this may differ among populations at risk for health disparities,” said Nakela L. Cook, M.D., the executive director of PCORI, in a statement. “We look forward to following the study’s progress and working with Wake Forest University School of Medicine to share the results.”