Table 3.
Incident Rate Ratios for Visit Rates by Patient Sociodemographic and Geographic Characteristics, Among Matched Children Cared for by Telemedicine-Using and Telemedicine Nonusing Subspecialists
| Subspecialist With No Telemedicine Use |
Subspecialist With Telemedicine use |
||||
|---|---|---|---|---|---|
| IRR | 95% CI | IRR | 95% CI | Interaction Term P value | |
| Dyads, N | 353,471 | 17,759 | |||
| Child sociodemographic characteristics | |||||
| Child age, y | <.001 | ||||
| <1 | 1 | Ref | 1 | Ref | |
| 1-5 | 0.54 | 0.54-0.55 | 0.51 | 0.47-0.54 | |
| 6-14 | 0.48 | 0.47-0.49 | 0.48 | 0.45-0.52 | |
| 15-17 | 0.47 | 0.47-0.48 | 0.50 | 0.47-0.54 | |
| Child Gender | |||||
| Female | 1 | Ref | 1 | Ref | |
| Male | 1.01 | 1.00-1.01 | 1.01 | 0.99-1.04 | |
| Child Race/Ethnicity | <0.001 | ||||
| White non-Hispanic | 1 | Ref | 1 | Ref | |
| Black non-Hispanic | 0.93 | 0.92-0.94 | 0.82 | 0.79-0.85 | |
| Hispanic or Latino/a/x | 0.96 | 0.95-0.97 | 0.90 | 0.86-0.93 | |
| Other, Multiple, or Unknown | 0.97 | 0.97-0.98 | 0.89 | 0.86-0.93 | |
| Child geographic characteristics | |||||
| Child residential county | <.001 | ||||
| Large metropolitan | 0.78 | 0.77-0.79 | 0.66 | 0.62-0.69 | |
| Small metropolitan | 0.86 | 0.85-0.87 | 0.89 | 0.86-0.93 | |
| Large urban | 0.85 | 0.84-0.86 | 0.79 | 0.74-0.83 | |
| Small urban | 1 | Ref | 1 | Ref | |
| Rural | 0.85 | 0.82-0.88 | 0.85 | 0.73-0.98 | |
| Child ZIP median income | <.001 | ||||
| 0-138% FPL | 0.94 | 0.93-0.95 | 1.15 | 1.08-1.22 | |
| 139-200% FPL | 0.99 | 0.98-1.00 | 0.99 | 0.94-1.04 | |
| 201-300% FPL | 1.02 | 1.01-1.03 | 0.91 | 0.87-0.96 | |
| >301% FPL | 1 | Ref | 1 | Ref | |
| Child distance to subspecialist | <.001 | ||||
| 0-30 miles | 1 | Ref | 1 | Ref | |
| 31-60 miles | 0.87 | 0.86-0.88 | 0.76 | 0.74-0.79 | |
| 61-90 miles | 0.84 | 0.83-0.85 | 0.72 | 0.68-0.75 | |
| >90 miles | 0.84 | 0.83-0.85 | 0.93 | 0.89-0.97 | |
| Child insurance characteristics | |||||
| Child Medicaid eligibility category | <.001 | ||||
| Financial | 1 | Ref | 1 | Ref | |
| Medical/disability | 1.18 | 1.17-1.19 | 1.01 | 0.97-1.04 | |
| Child Medicaid plan type | .001 | ||||
| Fee for service | 1 | Ref | 1 | Ref | |
| Managed care organization | 1.11 | 1.10-1.11 | 1.22 | 1.18-1.27 | |
IR indicates, incident risk ratio; CI, confidence interval; FPL, federal poverty level.
Incident risk ratios for children cared for by telemedicine-using and non-using subspecialists, determined through negative binomial regression on children matched through coarsened exact matching with child and subspecialist characteristics as independent variables, model offset for the number of months of child enrollment during 2014, and coarsened-exact matching weights with robust standard errors. In addition to listed characteristics, independent variables included subspecialist years in practice, gender, subspecialist type (medical vs surgical), and pediatric training (pediatric vs nonpediatric). In a full model, we tested the significance of all interaction terms together (P < .001) and each interaction term separately (provided in last column). Because all interaction terms together yielded a significant Wald test, final IRRs provided here were estimated through stratified negative binomial models.