title: Urban Telemedicine Enables Equity in Access to Acute Illness Care.
abstract: Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall.
  
  
  
  We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation.
  
  
  
  Health-e-Access Telemedicine was initiated in stepwise manner over 187 study-months among 74 access sites (childcare, schools, community centers), beginning in month 105. Children dwelled in inner city, rest-of-city Rochester, NY, or in surrounding suburbs. Rate of total acute care visits (office, ED, telemedicine) was measured as visits per 100 child-years. Observed utilization rates were adjusted in multivariate analysis for age, sex, insurance type, and season of year.
  
  
  
  When both suburban and inner-city children lacked telemedicine access, overall acute illness visits were 75% greater among suburban than inner-city children (suburban:inner-city rate ratio 1.75, p < 0.0001). After telemedicine became available to inner-city children, their overall acute visits approximated those of suburban children (suburban:inner-city rate ratio 0.80, p = 0.07), whereas acute visits among suburban children remained at least (worst-case comparison) 56% greater than inner-city children without telemedicine (rate ratio 1.56, p < 0.0001).
  
  
  
  At baseline, overall acute illness utilization of suburban children exceeded that of inner-city children. Overall utilization for inner-city children increased with telemedicine to that of suburban children at baseline. Without telemedicine, however, inner-city use remained substantially less than for suburban counterparts.
  
  
  
  Health-e-Access Telemedicine redressed socioeconomic disparities in acute care access in the Rochester area, thus contributing to a more equitable community.
authors.affiliation: 1 Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, UH Rainbow Babies and Children's Hospital , Cleveland, Ohio.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Ronis
authors.affiliation: 2 Department of Pediatrics, University of Rochester Medical Center , Rochester, New York.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: McConnochie
authors.affiliation: 3 Department of Biostatistics and Computational Biology, University of Rochester Medical Center , Rochester, New York.
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.affiliation: 4 Department of Emergency Medicine, University of Rochester Medical Center , Rochester, New York.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Wood
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D002654:Child Care / Q000458:organization & administration; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D011203:Poverty; D012574:Schools / Q000458:organization & administration; D012621:Seasons; D012737:Sex Factors; D012959:Socioeconomic Factors; D013383:Suburban Population / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: equity; healthcare access; information management; pediatrics; telehealth; telemedicine