95. Eating Disorder Care Via Telehealth: Telehealth Access and Quality of Care Among Young Adults and Adolescents, 2018-2022

In the U.S., 30 million people have an eating disorder (ED) and 95% are between 12 and 25. ED diagnoses are increasing and have high mortality. EDs require frequent medical visits for optimal care. However, ED specialty care in the U.S. is limited by both number of available providers and geographic location. The COVID-19 pandemic forced organizations to rely on telehealth to provide medical care, including specialty services. The impact of availability and quality of telehealth on the medical management of eating disorders is largely unknown. We hypothesize telehealth provides expanded access for eating disorder medical care and quality of care is preserved, whether patients are seen in person versus telehealth. We conducted a retrospective analysis of patients, ages 10-26, seen at Stanford Children's Health Eating Disorder Clinic (EDC) with ED related ICD10 codes. Two time periods represent pre pandemic period (pre, February 2018 to 2020) and post pandemic period (post, June 2020 to 2022). Data were abstracted from the Stanford Research Repository Tool. Preliminary analyses were conducted: descriptive statistics explored the cohort’s demographic characteristics, telehealth and in-person visits, visit status (completed or missed) and hospital admissions. There were 525 patients seen in EDC in the pre and 703 seen post. For completed EDC visits pre, there were 5.96 completed clinic visits per patient, largely in-person with a small number of telehealth visits (0.12 per patient). Post there were 2.82 completed clinic visits per patient in-person only, 5.25 completed clinic visits per patient via telehealth only, and 9.81 completed clinic visits per patient using both medians. For length of stay pre was 6.9 days vs. 8.4 days for those seen in person and via telehealth. Interestingly, patients seen via telehealth only had a length of stay of 4.8 days and 6.9 days for in-person only. On average, there were 0.79 hospital admissions per patient Pre compared to 0.91 hospital admissions per patient seen via telehealth and in-person Post. (Table 1) There is an increase of patients in EDC during post compared to pre. There is an increase in clinic visits for patients seen via both telehealth and in-person compared to telehealth or in-person only. There is an increase in hospital length of stay in post compared to pre, and an increasing trend of length of stay in-person visits only, telehealth visits only to a combination of both during post. There is also an increasing trend of admissions in-person visits only, telehealth visits only to a combination of both during post. Analysis revealed an overall increase in patients seen for eating disorders in the post-pandemic period, with trends that overall utilization (clinic visits, length of stay and hospital admissions) are higher for patients engaging both telehealth and in-person. Next steps include an evaluation of variables associated with in-person and telehealth visits, particularly as they impact quality of care.