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Foster M, Etchin A, Pope C, Hartmann CW, Emidio O, Bosworth HB. The Impact of COVID-19 on Hypertension and Hypertension Medication Adherence Among Underrepresented Racial and Ethnic Groups: A Scoping Review. Curr Hypertens Rep 2023; 25:385-394. [PMID: 37624472 DOI: 10.1007/s11906-023-01262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW To conduct a scoping review of articles which examined the impact of COVID-19 on HTN and HTN medication adherence among underrepresented racial/ethnic minorities. RECENT FINDINGS Seven studies were included in this review and impact of COVID-19 was examined at 4 levels: patient, provider, health system and society. The results indicated that patient level factors, such as high unemployment and inequitable access to telemedicine due to society factors- lack of access to high-speed Internet and variation in the offering of telehealth by health systems, were most impactful on adherence. Additionally, provider level clinical inertia may have further impacted adherence to HTN medication. Our review showed that the COVID-19 pandemic did not introduce new barriers but exacerbated preexisting barriers. Ongoing efforts are needed to change policies at the state and local levels to dismantle inequities in underrepresented communities to ensure access to health care with telemedicine to promote health equity.
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Affiliation(s)
- Marva Foster
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA.
- Boston University Chobanian & Avedisian School of Medicine, Department of General Internal Medicine, Boston, MA, USA.
- VA Boston Healthcare System, Department of Quality Management, 150 S. Huntington Ave., 02130, Boston, MA, USA.
| | - Anna Etchin
- VA Boston Healthcare System, Department of Quality Management, 150 S. Huntington Ave., 02130, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Charlene Pope
- Health Equity & Rural Outreach Innovation Center (HEROIC)/COIN, Ralph H. Johnson VA Health Care System, Charleston, SC, USA
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Christine W Hartmann
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Oluwabunmi Emidio
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
- Duke University School of Medicine, Department of Medicine, Division of General Internal Medicine, Durham, NC, USA
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
- Duke University Medical Center, School of Nursing, Durham, NC, USA
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Osmanlliu E, Kalwani NM, Parameswaran V, Qureshi L, Dash R, Scheinker D, Rodriguez F. Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic. Am Heart J 2023; 263:169-176. [PMID: 37369269 PMCID: PMC10290766 DOI: 10.1016/j.ahj.2023.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The COVID-19 pandemic accelerated adoption of telemedicine in cardiology clinics. Early in the pandemic, there were sociodemographic disparities in telemedicine use. It is unknown if these disparities persisted and whether they were associated with changes in the population of patients accessing care. METHODS We examined all adult cardiology visits at an academic and an affiliated community practice in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). We compared patient sociodemographic characteristics between these periods. We used logistic regression to assess the association of patient/visit characteristics with visit modality (in-person vs telemedicine and video- vs phone-based telemedicine) during the COVID period. RESULTS There were 54,948 pre-COVID and 58,940 COVID visits. Telemedicine use increased from <1% to 70.7% of visits (49.7% video, 21.0% phone) during the COVID period. Patient sociodemographic characteristics were similar during both periods. In adjusted analyses, visits for patients from some sociodemographic groups were less likely to be delivered by telemedicine, and when delivered by telemedicine, were less likely to be delivered by video versus phone. The observed disparities in the use of video-based telemedicine were greatest for patients aged ≥80 years (vs age <60, OR 0.24, 95% CI 0.21, 0.28), Black patients (vs non-Hispanic White, OR 0.64, 95% CI 0.56, 0.74), patients with limited English proficiency (vs English proficient, OR 0.52, 95% CI 0.46-0.59), and those on Medicaid (vs privately insured, OR 0.47, 95% CI 0.41-0.54). CONCLUSIONS During the first year of the pandemic, the sociodemographic characteristics of patients receiving cardiovascular care remained stable, but the modality of care diverged across groups. There were differences in the use of telemedicine vs in-person care and most notably in the use of video- vs phone-based telemedicine. Future studies should examine barriers and outcomes in digital healthcare access across diverse patient groups.
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Affiliation(s)
- Esli Osmanlliu
- McGill University Health Centre Research Institute, McGill University, Montréal, CA
| | - Neil M Kalwani
- VA Palo Alto Health Care System, Palo Alto, CA; Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.
| | - Vijaya Parameswaran
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Lubna Qureshi
- Digital Health Care Integration, Stanford Health Care, Stanford, CA
| | - Rajesh Dash
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, CA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
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Vrany EA, Hill-Briggs F, Ephraim PL, Myers AK, Garnica P, Fitzpatrick SL. Continuous glucose monitors and virtual care in high-risk, racial and ethnic minority populations: Toward promoting health equity. Front Endocrinol (Lausanne) 2023; 14:1083145. [PMID: 36761197 PMCID: PMC9905720 DOI: 10.3389/fendo.2023.1083145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Continuous glucose monitors (CGMs) have become an important tool to aid self-management of blood glucose for many patients with diabetes in the U.S., and the benefits of CGM use are well-documented. However, disparities in CGM use exist, with lower use in certain marginalized racial and ethnic groups. CGM may be an important and underutilized tool to help reduce inequities. Evidence supporting the use of CGMs as a part of virtual care is discussed, with an emphasis on designing virtual diabetes care programs to promote health equity. Recommendations for clinical practice and research are presented. In clinical practice, CGM should be an option for all people with diabetes who qualify based on clinical practice guidelines, regardless of race, ethnicity, or other individual characteristics. Future research should characterize the use of, benefit from, and preferences for CGM among individuals from racial and ethnic groups to guide interventions at the health system, clinic, provider, and patient levels to promote equitable, evidence-based, and guideline-directed CGM use in marginalized racial and ethnic groups with diabetes.
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Affiliation(s)
- Elizabeth A. Vrany
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- *Correspondence: Elizabeth A. Vrany,
| | - Felicia Hill-Briggs
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Patti L. Ephraim
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Alyson K. Myers
- Fleischer Institute for Diabetes and Metabolism, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Patricia Garnica
- Department of Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Stephanie L. Fitzpatrick
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
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Leung T, Greenhalgh T, Hughes G, Finlay T, Wherton J. Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage. J Med Internet Res 2022; 24:e42358. [PMID: 36383632 PMCID: PMC9773024 DOI: 10.2196/42358] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. OBJECTIVE This study aimed to review the literature on how multiple disadvantage-specifically, older age, lower socioeconomic status, and limited English proficiency-has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. METHODS Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. RESULTS Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. CONCLUSIONS A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities.
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Affiliation(s)
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Osmanlliu E, Burstein B, Tamblyn R, Buckeridge DL. Assessing the potential for virtualizable care in the pediatric emergency department. J Telemed Telecare 2022:1357633X221133415. [PMID: 36408736 DOI: 10.1177/1357633x221133415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
INTRODUCTION There is increasing interest for patient-to-provider telemedicine in pediatric acute care. The suitability of telemedicine (virtualizability) for visits in this setting has not been formally assessed. We estimated the proportion of in-person pediatric emergency department (PED) visits that were potentially virtualizable, and identified factors associated with virtualizable care. METHODS This was a retrospective analysis of in-person visits at the PED of a Canadian tertiary pediatric hospital (02/2018-12/2019). Three definitions of virtualizable care were developed: (1) a definition based on "resource use" classifying visits as virtualizable if they resulted in a home discharge, no diagnostic testing, and no return visit within 72 h; (2) a "diagnostic definition" based on primary ED diagnosis; and (3) a stringent "combined definition" by which visits were classified as virtualizable if they met both the resource use and diagnostic definitions. Multivariable logistic regression was used to identify factors associated with telemedicine suitability. RESULTS There were 130,535 eligible visits from 80,727 individual patients during the study period. Using the most stringent combined definition of telemedicine suitability, 37.9% (95% confidence interval (CI) 37.6%-38.2%) of in-person visits were virtualizable. Overnight visits (adjusted odds ratio (aOR) 1.16-1.37), non-Canadian citizenship (aOR 1.10-1.18), ethnocultural vulnerability (aOR 1.14-1.22), and a consultation for head trauma (aOR 3.50-4.60) were associated with higher telemedicine suitability across definitions. DISCUSSION There is a high potential for patient-to-provider telemedicine in the PED setting. Local patient and visit-level characteristics must be considered in the design of safe and inclusive telemedicine models for pediatric acute care.
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Affiliation(s)
- Esli Osmanlliu
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, 10040McGill University, Montréal, Canada
- Pediatric Emergency Medicine Division, 12367McGill University Health Center, McGill University, Montréal, Canada
- 507266McGill Clinical & Health Informatics (MCHI) Research Group, McGill University, Montréal, Canada
| | - Brett Burstein
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, 10040McGill University, Montréal, Canada
- Pediatric Emergency Medicine Division, 12367McGill University Health Center, McGill University, Montréal, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, 10040McGill University, Montréal, Canada
- 507266McGill Clinical & Health Informatics (MCHI) Research Group, McGill University, Montréal, Canada
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, 10040McGill University, Montréal, Canada
- 507266McGill Clinical & Health Informatics (MCHI) Research Group, McGill University, Montréal, Canada
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Adepoju OE, Angelocci T, Matuk-Villazon O. Increased Revenue From Averted Missed Appointments Following Telemedicine Adoption at a Large Federally Qualified Health Center. Health Serv Insights 2022; 15:11786329221125409. [PMID: 36186737 PMCID: PMC9520140 DOI: 10.1177/11786329221125409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
This study examined savings from averted missed appointments following telemedicine adoption. Data were obtained from a large Federally Qualified Health Center in Texas during the early pandemic months. Patient encounters fell into one of three categories: (1) in-person visit, (2) telemedicine alone with no support team engagement, and (3) telemedicine with previsit support team engagement for device and connectivity testing. Our findings revealed that in-person visits had a 21% missed appointment rate compared to 19% for telemedicine alone and 15% for telemedicine with previsit support. Translating the reductions following both telemedicine encounters into net reimbursement, telemedicine alone saved the Federally Qualified Health Center $16 444 per month, while telemedicine + support team reduced missed appointments and saved the clinic an additional $29 134. The revenue from averted missed appointments totaled $45 578 per month. In conclusion, telemedicine reduced missed appointments, and these averted missed appointments translated into cost-savings. Savings were more pronounced with the implementation of a support team that conducted previsit device and connectivity testing.
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Affiliation(s)
- Omolola E Adepoju
- University of Houston College of Medicine, Houston, TX, USA.,Humana Integrated Health System Sciences Institute, Houston, TX, USA
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7
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Peahl AF, Turrentine M, Barfield W, Blackwell SC, Zahn CM. Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations: A Practical Guide for Maternity Care Clinicians. J Womens Health (Larchmt) 2022; 31:917-925. [PMID: 35549536 DOI: 10.1089/jwh.2021.0589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Prenatal care is an important preventive service designed to improve the health of pregnant patients and their infants. Prenatal care delivery recommendations have remained unchanged since 1930, when the 12-14 in-person visit schedule was first established to detect preeclampsia. In 2020, the American College of Obstetricians and Gynecologists, in collaboration with the University of Michigan, convened a panel of maternity care experts to determine new prenatal care delivery recommendations. The panel recognized the need to include emerging evidence and experience, including significant changes in prenatal care delivery during the COVID-19 pandemic, pre-existing knowledge of the importance of individualized care plans, the promise of telemedicine, and the significant influence of social and structural determinants of health (SSDoH) on pregnancy outcomes. Recommendations were derived using the RAND-UCLA appropriateness method, a rigorous e-Delphi method, and are designed to extend beyond the acute public health crisis. The resulting Michigan Plan for Appropriate Tailored Healthcare in pregnancy (MiPATH) includes recommendations for key aspects of prenatal care delivery: (1) the recommended number of prenatal visits, (2) the frequency of prenatal visits, (3) the role of monitoring routine pregnancy parameters (blood pressure, fetal heart tones, weight, and fundal height), (4) integration of telemedicine into routine care, and (5) inclusion of (SSDoH). Resulting recommendations demonstrate a new approach to prenatal care delivery that incorporates medical, SSDoH, and patient preferences, to develop individualized prenatal care delivery plans. The purpose of this document is to outline the new MiPATH recommendations and to provide practical guidance on implementing them in routine practice.
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Affiliation(s)
- Alex Friedman Peahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Program on Women's Healthcare Effectiveness Research (PWHER), University of Michigan, Ann Arbor, Michigan, USA
| | - Mark Turrentine
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Wanda Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School-UTHealth, Houston, Texas, USA
| | - Christopher M Zahn
- American College of Obstetricians and Gynecologists, Washington, District of Columbia, USA
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Yan X, Stults CD, Deng S, Liang SY, Dillon E, Mudiganti S, Oscarson B, Jones JB, Frosch DL. Do Patients Continue to Use Video Visits? Factors Related to Continued Video Visit Use. Popul Health Manag 2022; 25:462-471. [PMID: 35353619 DOI: 10.1089/pop.2021.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Many studies have assessed the factors associated with overall video visit use during the COVID-19 pandemic, but little is known about who is most likely to continue to use video visits and why. The authors combined a survey with electronic health record data to identify factors affecting the continued use of video visit. In August 2020, a stratified random sample of 20,000 active patients from a large health care system were invited to complete an email survey on health care seeking preferences during the COVID. Weighted logistic regression models were applied, adjusting for sampling frame and response bias, to identify factors associated with video visit experience, and separately for preference of continued use of video visits. Actual video visit utilization was also estimated within 12 months after the survey. Three thousand three hundred fifty-one (17.2%) patients completed the survey. Of these, 1208 (36%) reported having at least 1 video visit in the past, lowest for African American (33%) and highest for Hispanic (41%). Of these, 38% would prefer a video visit in the future. The strongest predictors of future video visit use were comfort using video interactions (odds ratio [OR] = 5.30, 95% confidence interval [95% CI]: 3.57-7.85) and satisfaction with the overall quality (OR = 3.94, 95% CI: 2.66-5.86). Interestingly, despite a significantly higher satisfaction for Hispanic (40%-55%) and African American (40%-50%) compared with Asian (29%-39%), Hispanic (OR = 0.46, 95% CI: 0.12-0.88) and African American (OR = 0.54, 95% CI: 0.16-0.90) were less likely to prefer a future video visit. Disparity exists in the use of video visit. The association between patient satisfaction and continued video visit varies by race/ethnicity, which may change the future long-term video visit use among race/ethnicity groups.
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Affiliation(s)
- Xiaowei Yan
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Cheryl D Stults
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Sien Deng
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Su-Ying Liang
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Ellis Dillon
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Satish Mudiganti
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Brandon Oscarson
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - James B Jones
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Dominick L Frosch
- Health Science Diligence Advisors, LLC, Redwood City, California, USA
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Shucard H, Muller E, Johnson J, Walker J, Elmore JG, Payne TH, Berman J, Jackson SL. Clinical Use of an Electronic Pre-Visit Questionnaire Soliciting Patient Visit Goals and Interim History: A Retrospective Comparison Between Safety-net and Non-Safety-net Clinics. Health Serv Res Manag Epidemiol 2022; 9:23333928221080336. [PMID: 35198655 PMCID: PMC8859650 DOI: 10.1177/23333928221080336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction/Objectives We examined an initial step towards co-generation of clinic notes by inviting patients to complete a pre-visit questionnaire that could be inserted into clinic notes by providers and describe the experience in a safety-net and non-safety-net clinic. Methods We sent an electronic pre-visit questionnaire on visit goals and interim history to patients at a safety-net clinic and a non-safety-net clinic before clinic visits. We compared questionnaire utilization between clinics during a one-year period and performed a chart review of a sample of patients to examine demographics, content and usage of patient responses to the questionnaire. Results While use was low in both clinics, it was lower in the safety-net clinic (3%) compared to the non-safety-net clinic (10%). We reviewed a sample of respondents and found they were more likely to be White compared to the overall clinic populations ( p < 0.05). There were no statistically significant differences in patient-typed notes (word count and number of visit goals) between the safety-net and non-safety-net samples however, patients at the safety-net clinic were less likely to have all of their goals addressed within the PCP documentation, compared to the non-safety-net clinic. Conclusions Given potential benefits of this questionnaire as a communication tool, addressing barriers to use of technology among vulnerable patients is needed, including access to devices and internet, and support from caregivers or culturally concordant peer navigators.
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Affiliation(s)
| | - Emily Muller
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Jan Walker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Joann G. Elmore
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas H. Payne
- University of Washington School of Medicine, Seattle, WA, USA
| | - Jacob Berman
- University of Washington School of Medicine, Seattle, WA, USA
| | - Sara L. Jackson
- University of Washington School of Medicine, Seattle, WA, USA
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Kokorelias KM, Nelson MLA, Tang T, Steele Gray C, Ellen M, Plett D, Jarach CM, Xin Nie J, Thavorn K, Singh H. Who is Included in Digital Health Technologies to Support Hospital to Home Transitions for Older Adults?: Secondary analysis of a rapid review and equity-informed recommendations (Preprint). JMIR Aging 2021; 5:e35925. [PMID: 35475971 PMCID: PMC9096639 DOI: 10.2196/35925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Kristina Marie Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Sinai Health System/University Health Network, Toronto, ON, Canada
| | - Michelle LA Nelson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Moriah Ellen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Eilat, Israel
- Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Eilat, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Eilat, Israel
| | - Donna Plett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Carlotta Micaela Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Hardeep Singh
- March of Dimes Canada, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Osmanlliu E, Gagnon I, Weber S, Bach CQ, Turnbull J, Seguin J. The Waiting Room Assessment to Virtual Emergency Department pathway: Initiating video-based telemedicine in the pediatric emergency department. J Telemed Telecare 2021; 28:452-457. [PMID: 34636683 DOI: 10.1177/1357633x211044038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has presented pediatric emergency departments with unique challenges, resulting in a heightened demand for adapted clinical pathways. In response to this need, the Montreal Children's Hospital pediatric emergency department introduced the WAVE (Waiting Room Assessment to Virtual Emergency Department) pathway, a video-based telemedicine pathway for selected non-critical patients, aiming to reduce safety issues related to emergency department overcrowding, while providing timely care to all children presenting and registering at our emergency department. The objective of the WAVE pilot phase was to evaluate the feasibility and acceptability of telemedicine in our pediatric emergency department, which was previously unfamiliar with this mode of care delivery. During the six-week, three-evening per week deployment, we conducted 18 five-hour telemedicine shifts. In total, 27 patients participated in the WAVE pathway. Results from this pilot phase met four of five a priori feasibility and acceptability criteria. Overall, participating families were satisfied with this novel care pathway and reported no disruptive technological barriers.
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Affiliation(s)
- Esli Osmanlliu
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Canada.,507266Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Isabelle Gagnon
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Canada.,507266Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Saskia Weber
- Quality and Continuous Improvement Office, 10040Montreal Children's Hospital, Canada
| | - Chi Quan Bach
- Partnership Office, 54473McGill University Health Centre, Canada
| | - Jennifer Turnbull
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Canada
| | - Jade Seguin
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Canada.,507266Research Institute of the McGill University Health Centre (RI-MUHC)
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12
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Croswell JM, Corley DA, Lafata JE, Haas JS, Inadomi JM, Kamineni A, Ritzwoller DP, Vachani A, Zheng Y. Cancer screening in the U.S. through the COVID-19 pandemic, recovery, and beyond. Prev Med 2021; 151:106595. [PMID: 34217414 PMCID: PMC8722181 DOI: 10.1016/j.ypmed.2021.106595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 has proved enormously disruptive to the provision of cancer screening, which does not just represent an initial test but an entire process, including risk detection, diagnostic follow-up, and treatment. Successful delivery of services at all points in the process has been negatively affected by the pandemic. There is a void in empirical high-quality evidence to support a specific strategy for administering cancer screening during a pandemic and its resolution phase, but several pragmatic considerations can help guide prioritization efforts. Targeting guideline-eligible people who have never been screened, or those who are significantly out of date with screening, has the potential to maximize benefits now and into the future. Disruptions to care due to the pandemic could represent an unparalleled opportunity to reassess early detection programs towards an explicit, thoughtful, and just prioritization of populations historically experiencing cancer disparities. By focusing screening services on populations that have the most to gain, and by careful and deliberate planning for the period following the pandemic, we can positively affect cancer outcomes for all.
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Affiliation(s)
- Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, USA.
| | - Douglas A Corley
- The Permanente Medical Group, Kaiser Permanente, Northern California, USA
| | - Jennifer Elston Lafata
- University of North Carolina Lineberger Comprehensive Cancer Center and Eshelman School of Pharmacy, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, USA
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, USA
| | | | - Anil Vachani
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, USA
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13
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Mo A, Chung J, Eichler J, Yukelis S, Feldman S, Fox J, Garg M, Kalnicki S, Ohri N, Sparano JA, Klein J. Breast cancer survivorship care during the COVID-19 pandemic within an urban New York Hospital System. Breast 2021; 59:301-307. [PMID: 34385028 PMCID: PMC8334511 DOI: 10.1016/j.breast.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine clinicodemographic determinants associated with breast cancer survivorship follow-up during COVID-19. Methods We performed a retrospective, population-based cohort study including early stage (Stage I-II) breast cancer patients who underwent resection between 2006 and 2018 in a New York City hospital system. The primary outcome was oncologic follow-up prior to and during the COVID-19 pandemic. Secondary analyses compared differences in follow-up by COVID-19 case rates stratified by ZIP code. Results A total of 2942 patients with early-stage breast cancer were available for analysis. 1588 (54%) of patients had attended follow-up in the year prior to the COVID-19 period but failed to continue to follow-up during the pandemic, either in-person or via telemedicine. 1242 (42%) patients attended a follow-up appointment during the COVID-19 pandemic. Compared with patients who did not present for follow-up during COVID-19, patients who continued their oncologic follow-up during the pandemic were younger (p = 0.049) more likely to have received adjuvant radiation therapy (p = 0.025), and have lower household income (p = 0.031) on multivariate modeling. When patients who live in Bronx, New York, were stratified by ZIP code, there was a modest negative association (r = −0.56) between COVID-19 cases and proportion of patients who continued to follow-up during the COVID-19 period. Conclusion We observed a dramatic disruption in routine breast cancer follow-up during the COVID-19 pandemic. Providers and health systems should emphasize reintegrating patients who missed appointments during COVID-19 back into regular surveillance programs to avoid significant morbidity and mortality from missed breast cancer recurrences. A dramatic disruption in routine oncologic follow-up was observed during the COVID-19 period. Over half of patients with breast cancer at our center did not attend routine oncologic follow-up during COVID-19. Patients who were younger, had lower SES, and who received radiotherapy were more likely to follow-up during the pandemic. A modest negative association was observed between local ZIP code COVID-19 infection rates and follow-up attendance rate.
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Affiliation(s)
- Allen Mo
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Julie Chung
- Health Information Management, Cancer Registry, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeremy Eichler
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Sarah Yukelis
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Sheldon Feldman
- Department of Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jana Fox
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Madhur Garg
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Nitin Ohri
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Joseph A Sparano
- Department of Medical Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jonathan Klein
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
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14
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McClellan M, Rajkumar R, Couch M, Holder D, Pham M, Long P, Medows R, Navathe A, Sandy L, Shrank W, Smith M. Health Care Payers COVID-19 Impact Assessment: Lessons Learned and Compelling Needs. NAM Perspect 2021; 2021:202105a. [PMID: 34532685 PMCID: PMC8406497 DOI: 10.31478/202105a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | | | | | | | - Rhonda Medows
- Providence St. Joseph Health and Ayin Health Solutions
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15
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Bateman EA, Sreenivasan VA, Farahani F, Casemore S, Chase AD, Duley J, Evbuomwan IK, Flett HM, Ventre A, Craven BC, Wolfe DL. Improving practice through collaboration: Early experiences from the multi-site Spinal Cord Injury Implementation and Evaluation Quality Care Consortium. J Spinal Cord Med 2021; 44:S147-S158. [PMID: 34779729 PMCID: PMC8604479 DOI: 10.1080/10790268.2021.1936946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Dedicated implementation efforts are critical to bridging the gaps between current practices and best practices. A quality improvement collaborative (QIC), the Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC), was established to meet this need, bringing together a network of clinicians and administrators to systematically improve the quality and equity of tertiary spinal cord injury or disease (SCI/D) rehabilitation care in Ontario, Canada. METHODS Clinicians and leaders from five tertiary SCI/D rehabilitation centers and two not-for-profit SCI/D advocacy groups comprised a network dedicated to supporting implementation of the SCI-High quality indicators in prioritized domains of SCI rehabilitation and related best practices by: (1) building capacity through implementation science education of frontline clinicians; (2) providing resources and support to empower frontline clinicians to lead quality improvement efforts within their institutions; (3) promoting wider learning through a network for sharing ideas, efforts, and experiences; and (4) collecting indicator data to facilitate provincial evaluation of goal attainment. RESULTS Network members and sites collaborated to implement best practices within six priority domains; in 18 months, significant progress has been made in emotional wellbeing, sexual health, walking, and wheeled mobility despite disruptions due to the COVID-19 pandemic. These efforts encompass heterogeneous challenges and strategies, ranging from developing clinical skills programs, to streamlining processes, to manipulating physical space. CONCLUSION A QIC targeting SCI/D rehabilitation demonstrates promise for advancing the implementation of best practices, building implementation science capacity across multiple sites, and for promoting collaboration amongst SCI/D rehabilitation centers and organizational partners.
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Affiliation(s)
- Emma A. Bateman
- Department of Physical Medicine & Rehabilitation, Western University, London, Canada
- Parkwood Institute, St. Joseph’s Health Care London, London, Canada
| | | | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
| | | | | | | | - Ivie K. Evbuomwan
- Parkwood Institute Research, Lawson Health Research Institute, London, Canada
| | - Heather M. Flett
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Brain and Spinal Cord Rehabilitation Program Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Anellina Ventre
- Brain and Spinal Cord Rehabilitation Program Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Brain and Spinal Cord Rehabilitation Program Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - Dalton L. Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, Canada
- School of Health Studies, Western University, London, Canada
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16
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Gilson SF, Umscheid CA, Laiteerapong N, Ossey G, Nunes KJ, Shah SD. Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis. JMIR Med Inform 2020; 8:e24544. [PMID: 33191247 PMCID: PMC7721629 DOI: 10.2196/24544] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. Objective The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. Methods We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. Results Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. Conclusions Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.
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Affiliation(s)
- Sarah F Gilson
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Craig A Umscheid
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States
| | - Graeme Ossey
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States.,Digital Health, University of Chicago Medicine, Chicago, IL, United States
| | - Kenneth J Nunes
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, United States
| | - Sachin D Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL, United States.,Department of Pediatrics, University of Chicago, Chicago, IL, United States
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