{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T12:45:28Z","timestamp":1786193128852,"version":"build-2736575974"},"reference-count":49,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Telemed Telecare"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Accessing specialty cardiac care presents challenges for U.S. individuals with congenital heart defects (CHD), despite recommendations for regular cardiac follow-up. Additionally, the impact of the COVID-19 pandemic and telehealth expansion on CHD-related health care is not well-understood. Therefore, our objective was to evaluate changes in CHD-related telehealth and other outpatient utilization in the Medicaid population from 2018 to 2022 and a privately-insured population from 2018 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using claims from national Medicaid (2018\u20132022) and private insurance (2018\u20132023) databases, we calculated the number of CHD-related outpatient encounters per 100,000 enrolled children or adults and the number conducted via telehealth. We compared CHD-related outpatient utilization trends before and after the COVID-19 interruption (identified as March\u2013May 2020) as an interrupted times series with Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among adults and children in both insured populations, CHD-related outpatient utilization increased before the COVID-19 interruption (January 2018\u2013February 2020); afterward, it decreased in Medicaid but continued increasing at a slower rate among the privately-insured (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u20090.01). For children, CHD-related outpatient utilization in June 2020 was lower (8%\u2013Medicaid, 5%\u2013private) than would be expected without the interruption (both\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u20090.01). Though &lt;1% pre-pandemic, recent (2022\/2023) telehealth utilization accounted for 1%\u20134% of pediatric and adult outpatient CHD-related encounters in both databases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>CHD-related outpatient care has declined among Medicaid beneficiaries and slowed among private insurance beneficiaries since the COVID-19 interruption, and efforts may be needed to re-engage CHD patients in regular outpatient cardiac care. Telehealth may be an underutilized option to improve access to CHD care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1357633x261474306","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:56:57Z","timestamp":1786024617000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Congenital heart defect (CHD)-related telehealth and other outpatient utilization among Medicaid and private insurance beneficiaries: 2018\u20132023"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3063-1781","authenticated-orcid":false,"given":"Karrie F","family":"Downing","sequence":"first","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9773-9009","authenticated-orcid":false,"given":"Sherry L","family":"Farr","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E","family":"Oster","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"},{"name":"Division of Cardiology, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley S","family":"Marino","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E","family":"Rose","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5312-7596","authenticated-orcid":false,"given":"Emily O","family":"Olsen","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2008.05.059"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01886-7"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019307"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951121002766"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-024-03414-y"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2021.02.018"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/pd.6481"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000478"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001107"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951120004758"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2023.08.010"},{"key":"e_1_3_3_13_2","article-title":"Exploring the promise of telemedicine exercise interventions in children and adolescents with congenital heart disease","volume":"39","author":"Spence C","year":"2023","unstructured":"Spence C, Khoo N, Mackie A, et al. Exploring the promise of telemedicine exercise interventions in children and adolescents with congenital heart disease. 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