Through the proposed work, we aim to produce a valid and reliable parent-reported Child Clinician and Group Consumer Assessment of Healthcare Providers and Systems (Child CG CAHPS) Telemedicine Survey that will have great potential to increase the patient-centeredness of care, improve experiences of care and health outcomes, and reduce disparities for pediatric patients and their families. Telemedicine, now being adopted at an unprecedented rate due to COVID-19, has become, and will remain, a mainstay of the care we provide. This survey will allow us to measure a critical component of the quality of telemedicine that will highlight variation in performance and provide targets for improvement which are essential for providing high quality care. In the formative phase of our work, we will gather input on telemedicine from a variety of stakeholders, including interviews with academic, clinical, and QI experts, public comment through a federal register notice, and 8 focus groups with parents and adolescents (13-17 years old) from around the United States (US) in English and Spanish. We will use key stakeholder interviews and virtual focus groups to gain novel insights into telemedicine. Using what we learn from our formative work, we will develop a draft survey instrument. We will then conduct cognitive interviews with parents in English and Spanish from around the US to assess whether items are understandable and meaningful to respondents. We will revise the survey instrument before pilot testing it in three clinics. After analyzing results from the pilot, we will revise the draft survey and conduct a national field test in 30 US clinics. The Child CG CAHPS Telemedicine Survey will be administered by survey vendors on behalf of participating clinics. We will analyze data from the national field test to assess the validity, reliability, feasibility, and usability of our survey. We will also conduct end-user testing with parents from around the US in English and Spanish to evaluate the understandability of our measure labels and concepts before finalizing the survey instrument. Our final products will include a valid and reliable Child CG CAHPS Telemedicine Survey for use in the pediatric clinic setting. The development of such a survey is critical for continuing to assess the quality of pediatric healthcare via the patient and family experience of care, for assessing how telemedicine may contribute to the narrowing or widening of disparities, and for evaluating practice and system performance.

Public Health Relevance

We aim to examine key stakeholder understanding of and experiences with telemedicine which will inform our plan to adapt and expand the existing Child Clinician and Group Consumer Assessment of Healthcare Providers and Systems Survey to reflect the emergence of telemedicine as a mode for delivering medical care to diverse populations. We plan to conduct extensive formative work that will include a measures review, key stakeholder interviews, a public comment period, and parent and adolescent focus groups. We will use what we learn to develop a telemedicine measure set drawing on cognitive interviews, a pilot and national field test, and end-user testing.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration--Cooperative Agreements (U18)
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Special Emphasis Panel (ZHS1)
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Harding, Brenda
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Boston Children's Hospital
United States
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Wisk, Lauren E; Finkelstein, Jonathan A; Toomey, Sara L et al. (2018) Impact of an Individual Mandate and Other Health Reforms on Dependent Coverage for Adolescents and Young Adults. Health Serv Res 53:1581-1599
Nakamura, Mari M; Zaslavsky, Alan M; Toomey, Sara L et al. (2017) Pediatric Readmissions After Hospitalizations for Lower Respiratory Infections. Pediatrics 140:
Chien, Alyna T; Kuhlthau, Karen A; Toomey, Sara L et al. (2017) Quality of Primary Care for Children With Disabilities Enrolled in Medicaid. Acad Pediatr 17:443-449
Sawicki, Gregory S; Garvey, Katharine C; Toomey, Sara L et al. (2017) Preparation for Transition to Adult Care Among Medicaid-Insured Adolescents. Pediatrics 140:
Toomey, Sara L; Elliott, Marc N; Zaslavsky, Alan M et al. (2017) Variation in Family Experience of Pediatric Inpatient Care As Measured by Child HCAHPS. Pediatrics 139:
Feng, Jeremy Y; Toomey, Sara L; Zaslavsky, Alan M et al. (2017) Readmission After Pediatric Mental Health Admissions. Pediatrics 140: