TABLE 1.
Characteristics of ARI Visits Before and After Matching, 2015–2016
| Pediatric Visits | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Before Matching | After Matchinga | |||||||||
| DTC Telemedicine, No. (%) | Urgent Care, No. (%) | Standardized Difference,b % | PCP, No. (%) | Standardized Difference,b % | DTC Telemedicine, No. (%) | Urgent Care, No. (%) | Standardized Difference,b % | PCP, No. (%) | Standardized Difference,b % | |
| Visits, N | 5431 | 87 555 | — | 1 132 116 | — | 4604 | 38 408 | — | 485 201 | — |
| Child age, y | ||||||||||
| 0–1 | 245 (5) | 8234 (9) | 59.0 | 195 692 (17) | 89.6 | 224 (5) | 1956 (5) | 4.7 | 24 192 (5) | 2.5 |
| 2–5 | 1305 (24) | 24 845 (28) | 21.5 | 390 699 (35) | 46.4 | 1132 (25) | 9528 (25) | 1.2 | 121 932 (25) | 2.9 |
| 6–11 | 1930 (36) | 30 018 (34) | 5.6 | 331 716 (29) | 30.1 | 1614 (35) | 13 392 (35) | 0.8 | 168 036 (35) | 1.9 |
| 12–17 | 1951 (36) | 24 458 (28) | 39.3 | 214 009 (19) | 110.7 | 1634 (35) | 13 532 (35) | 1.1 | 171 041 (35) | 1.0 |
| Sex | ||||||||||
| Female | 2755 (51) | 44 181 (50) | 1.1 | 555 277 (49) | 6.7 | 2339 (51) | 19 513 (51) | 0 | 246 500 (51) | 0 |
| Male | 2676 (49) | 43 374 (50) | — | 576 839 (51) | — | 2265 (49) | 18 895 (49) | — | 238 701 (49) | — |
| Chronic medical complexityc | ||||||||||
| No chronic conditions | 3993 (74) | 65 931 (75) | 9.5 | 835 897 (74) | 1.6 | 3542 (77) | 29 548 (77) | 0 | 373 280 (77) | 0 |
| Noncomplex chronic condition | 1062 (20) | 14 823 (17) | 18.5 | 197 934 (17) | 14.3 | 803 (17) | 6699 (17) | 0 | 84 626 (17) | 0 |
| Complex chronic condition | 376 (7) | 6801 (8) | 11.9 | 98 285 (9) | 22.2 | 259 (6) | 2161 (6) | 0 | 27 295 (6) | 0 |
| Rural or urband | ||||||||||
| Metropolitan | 4967 (91) | 81 028 (93) | 15.7 | 1 052 233 (93) | 22.7 | 4415 (96) | 36 839 (96) | 0.5 | 465 266 (96) | 0.1 |
| Micropolitan | 284 (5) | 4421 (5) | 3.7 | 48 849 (4) | 22.1 | 140 (3) | 1161 (3) | 0.6 | 14 771 (3) | 0.1 |
| Small town | 109 (2) | 1449 (2) | 21.4 | 20 540 (2) | 10.8 | 34 (1) | 284 (1) | 0 | 3583 (1) | 0 |
| Rural | 71 (1) | 657 (1) | 71.7 | 10 494 (1) | 41.3 | 15 (0) | 125 (0) | 0 | 1581 (0) | 0 |
| Region | ||||||||||
| Northeast | 627 (12) | 5691 (7) | 79.7 | 346 792 (31) | 90.0 | 490 (11) | 4088 (11) | 0 | 51 640 (11) | 0 |
| Midwest | 929 (17) | 16 393 (19) | 10.7 | 161 878 (14) | 22.9 | 701 (15) | 5833 (15) | 0.3 | 73 876 (15) | 0 |
| South | 2943 (54) | 42 860 (49) | 21.0 | 445 160 (39) | 62.3 | 2587 (56) | 21 757 (57) | 1.9 | 275 657 (57) | 2.5 |
| West | 932 (17) | 22 611 (26) | 45.8 | 178 286 (16) | 10.6 | 826 (18) | 6730 (18) | 2.9 | 84 029 (17) | 4.3 |
| HDHP | ||||||||||
| No | 4575 (84) | 81 720 (93) | 136.2 | 1 062 214 (94) | 164.3 | 4119 (89) | 34 362 (89) | 0 | 434 088 (89) | 0 |
| Yes | 856 (16) | 5835 (7) | — | 69 902 (6) | — | 485 (11) | 4046 (11) | — | 51 113 (11) | — |
| Diagnosis categorye | ||||||||||
| Sinusitis | 966 (18) | 7101 (8) | 122.1 | 113 392 (10) | 85.9 | 646 (14) | 5389 (14) | 0 | 68 080 (14) | 0 |
| Streptococcal pharyngitis | 326 (6) | 11 745 (13) | 65.6 | 103 066 (9) | 37.5 | 250 (5) | 2086 (5) | 0 | 26 347 (5) | 0 |
| Otitis media | 429 (8) | 22 838 (26) | 96.9 | 263 743 (23) | 86.4 | 369 (8) | 3078 (8) | 0 | 38 888 (8) | 0 |
| Viral ARIf | 3710 (68) | 46 979 (54) | 59.1 | 664 912 (59) | 39.5 | 3339 (73) | 27 855 (73) | 0 | 351 887 (73) | 0 |
—, not applicable.
Sample characteristics before and after matching. In comparison of matched samples, each stratum of matched sets is weighted to account for differences in the number of matched urgent care and PCP visits. Counts within the matched categories may exceed column total because of rounding of weighted frequencies. Visits were matched by age (in years) and state, but results are reported in the table by larger categories of age group and census region.
Standardized differences comparing the characteristics of urgent care or PCP visits (in the column to the left) to DTC telemedicine, before and after matching.
Patient chronic medical complexity was determined by using the Pediatric Medical Complexity Algorithm applied to all 2014–2016 inpatient and outpatient claims for each patient.29 This algorithm is used to identify children with 3 levels of chronic medical complexity: complex chronic disease, (ie, significant multisystem chronic disease, progressive conditions with decreased life expectancy, technology dependence, or malignancy), noncomplex chronic disease (ie, chronic conditions such as asthma that do not meet the above criteria), and no chronic disease.
Rural or urban status was determined by using the US Department of Agriculture rural-urban commuting area codes.
Because a small percentage of visits have >1 of these diagnoses (1.1%), percentages for diagnosis category may sum to >100%.
Viral ARI category consists of diagnoses for which antibiotics are not warranted (eg, viral URI, bronchiolitis, viral pharyngitis, and serous otitis media) in the absence of another diagnosis.