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Original Investigation
September 9, 2019

Association of a School-Based, Asthma-Focused Telehealth Program With Emergency Department Visits Among Children Enrolled in South Carolina Medicaid

Author Affiliations
  • 1Department of Medicine, Medical University of South Carolina, Charleston
  • 2Department of Pediatrics, Medical University of South Carolina, Charleston
JAMA Pediatr. 2019;173(11):1041-1048. doi:10.1001/jamapediatrics.2019.3073
Key Points

Question  Do school-based telehealth programs deliver health benefits at the community level?

Findings  In this Medicaid claims data analysis, there was no association found between a school-based telehealth program implemented in a rural South Carolina county and all-cause emergency department visits among children ages 3 to 17 years enrolled in Medicaid. However, an additional analysis of a subsample of children with asthma suggested that this program was associated with a more than 20% overall reduction in emergency department visits.

Meaning  Telehealth programs with a focus on chronic pediatric diseases, such as asthma, may improve children’s health in rural and medically underserved communities.


Importance  Telehealth may improve access to care for populations in rural communities. However, little is known about the effectiveness of telehealth programs designed for children.

Objective  To examine the associations of a school-based telehealth program in Williamsburg county (South Carolina) with all-cause emergency department (ED) visits made by children enrolled in Medicaid.

Design, Setting, and Participants  This Medicaid claims data analysis was conducted in Williamsburg county and 4 surrounding counties in South Carolina and included children aged 3 to 17 years who were enrolled in Medicaid and living in any of the 5 counties from January 2012 to December 2017. Williamsburg served as the intervention and the 4 surrounding counties without a telehealth program as the control; 2012 to 2014 was designated as the preintervention period, whereas 2015 to 2017 served as the postintervention period. The study was designed with a difference-in-differences specification, in which the unit-of-analysis was a child-month, and a subsample included children with asthma. The data analysis was performed from July 2018 to February 2019.

Exposures  The school-based telehealth program implemented in Williamsburg county in 2015.

Main Outcomes and Measures  The binary outcome was the status of at least 1 all-cause ED visit by a child in a given month.

Results  The full sample included 2 443 405 child-months from 23 198 children in Williamsburg county and 213 164 children in the control counties. The mean (SD) proportions of monthly ED visits in Williamsburg were 3.65% (0.10%) during the preintervention and 3.87% (0.11%) during the postintervention. The corresponding proportions of the 4 control counties were 3.37% preintervention (0.04%), and 3.56% postintervention (0.04%), respectively. The trends in the proportion were paralleled. In the asthma subsample, the proportions in Williamsburg were 3.16% (0.31%) during the preintervention and 3.38% (0.34%) during the postintervention, respectively. The proportions for the control counties were 3.02% preintervention (0.10%) and 3.90% postintervention (0.11%), respectively. There was an interaction of the proportions between the pre/postintervention period and the intervention/control counties in this subsample. The regression analysis of the full sample showed no association of the telehealth program with ED visits. The additional analysis of the asthma subsample showed that this program was associated with a reduction of 0.66 (95% CI, −1.16 to −0.17; P < .01) percentage point per 100 children per month in ED visits, representing an approximately 21% relative decrease.

Conclusions and Relevance  Although we found no association of this program with the ED visits of the overall studied population, this study suggests that telehealth with a focus on chronic pediatric diseases, such as asthma, may deliver substantial health benefits to rural and medically underserved communities.

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