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McGrath BM, Goueth R, Jones MWH, Cook N, Navale SM, Zyzanski SJ, Bensken WP, Templeton AR, Koroukian SM, Crist RL, Stange KC. Care Quality and Equity in Health Centers During and After the COVID-19 Pandemic. Am J Prev Med 2024; 67:485-493. [PMID: 38788862 DOI: 10.1016/j.amepre.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Federally Qualified Community Health Centers (FQHCs) are on the frontline of efforts to improve healthcare equity and reduce disparities exacerbated by the COVID-19 pandemic. This study assesses the provision and equity of preventive care and chronic disease management by FQHCs before, during, and after the pandemic. METHODS Using electronic health record data from 210 FQHCs nationwide and employing segmented regression in an interrupted time series design, preventive screening and chronic disease management were assessed for 939,053 patients from 2019 to 2022. Care measures included cancer screenings, blood pressure control, diabetes control, and childhood immunizations; patient-level factors including race and ethnicity, language preference, and multimorbidity status were analyzed for equitable care provision. Analyses were conducted in 2023-2024. RESULTS Cancer screening rates and blood pressure control initially declined after the onset of the pandemic but later rebounded, while diabetes control showed a slight increase, later stabilizing. Racial and ethnic disparities persisted, with Asian individuals having a higher prevalence of screenings and blood pressure control, and Black/African American individuals facing a lower prevalence for most screenings but a higher prevalence for cervical cancer screening. Hispanic/Latino individuals had a higher prevalence of various screenings and diabetes control. Disparities persisted for Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native individuals and were observed based on language and multimorbidity status. CONCLUSIONS While preventive screening and chronic disease management in FQHCs have largely rebounded to pre-pandemic levels following an initial decline, persistent disparities highlight the need for targeted interventions to support FQHCs in addressing healthcare inequities.
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Affiliation(s)
| | - Rose Goueth
- Research Department, OCHIN, Inc., Portland, Oregon
| | | | - Nicole Cook
- Research Department, OCHIN, Inc., Portland, Oregon
| | | | - Stephen J Zyzanski
- Center for Community Health Integration and Departments of Family Medicine & Community Health and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Siran M Koroukian
- Center for Community Health Integration and Departments of Family Medicine & Community Health and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Rae L Crist
- Research Department, OCHIN, Inc., Portland, Oregon
| | - Kurt C Stange
- Research Department, OCHIN, Inc., Portland, Oregon; Center for Community Health Integration and Departments of Family Medicine & Community Health and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
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2
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Margerison CE, Wang X, Gemmill A, Goldman-Mellor S. Pregnancy-associated mortality during the pandemic: disparities by rurality. Am J Prev Med 2024:S0749-3797(24)00306-4. [PMID: 39277061 DOI: 10.1016/j.amepre.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 09/08/2024] [Accepted: 09/08/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION In the US, rural areas experience higher rates of adverse maternal health outcomes, but little data exists on rural/urban differences in pregnancy-associated deaths (PAD, all deaths during pregnancy and postpartum) or rural/urban differences in those deaths during the COVID-19 pandemic. METHODS Cross-sectional US vital statistics mortality data from 2018 to 2021 was used to identify PAD (analyzed in 2024). PAD ratios (deaths per 100,000 live births) and 95% confidence intervals (CIs) were calculated by year, cause, and rurality (urban, suburban, rural). The percent change in PAD ratios between the pre-pandemic (2018 and 2019) and pandemic (2020 and 2021) time periods was calculated by rurality. RESULTS During the pandemic, rural-compared to suburban and urban-areas had the highest pregnancy-associated death ratios due to obstetric causes (53.9 deaths/100,000 live births, 95%CI: 48.8, 59.4), drug-related causes (19.0, 95%CI: 16.0, 22.4), suicide (4.4., 95%CI: 3.0, 6.2), and other causes (the majority of which are motor vehicle accidents, 16.4, 95%CI: 14.0, 19.6). Rural areas experienced increases in all causes of pregnancy-associated death from pre-pandemic (2018 and 2019) to pandemic (2020 and 2021) with increases of 48.1% in obstetric deaths, 115.9% in drug-related deaths, 17.8% in homicide, 25.7% in suicide, and 11.6% in other causes. Rural areas experienced the largest (compared to urban and suburban) increase in drug-related deaths, and only rural areas experienced an increase in suicide during the pandemic. CONCLUSIONS Rural areas experience a high burden of pregnancy-associated death, and this inequity was exacerbated during the COVID-19 pandemic.
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Affiliation(s)
- Claire E Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.
| | - Xueshi Wang
- Department of Economics, Michigan State University, East Lansing, Michigan
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA
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3
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Wiley K, Pugh A, Brown-Podgorski BL, Jackson JR, McSwain D. Associations Between Telemedicine Use Barriers, Organizational Factors, and Physician Perceptions of Care Quality. Telemed J E Health 2024. [PMID: 39229753 DOI: 10.1089/tmj.2024.0249] [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: 09/05/2024] Open
Abstract
Introduction: Evaluating physician perceptions of telemedicine use and its impact on care quality among physician providers is critical to sustaining telemedicine programs, given the uncertainty of reimbursement policy, preferences, inadequate training, and technical difficulties. Physicians reported technical barriers to effectively practicing integrated medicine using telemedicine as patient volumes increased during the pandemic. The objective of this work was to examine whether perceived practice barriers and facilitators were associated with physician respondents' perceptions of telemedicine care quality compared with in-person care. Methods: This cross-sectional study analyzed the 2021 National Electronic Health Record Survey. The sample comprised 1,857 nonfederally employed physicians (weighted n = 403,013) delivering integrated patient care. Of those physicians, 1,630 (weighted n = 346,646) reported providing care through telemedicine. We reported frequencies and percentages of reported practice characteristics. Generalized ordinal logistic regressions examined relationships between practice factors and care quality for telemedicine care. Results: Most of the sample (n = 1,630) were male (66.1%), >50 years of age (66.1%), and worked in a single location (73.5%). A total of 70% of respondents reported that patients had difficulty using telemedicine platforms, and 64% reported limitations in patients' access to technology. Most respondents indicated having provided quality care to some extent (45%) and to a great extent (26%) during telemedicine visits compared to in-person visits. Associations between barriers, facilitators, and care quality perceptions were positive, underscoring resiliency in telemedicine programs among practices. Conclusion: Care modalities and the organizational, environmental, and personal facilitators drive quality perceptions among physicians. Perceived fit and usability determine perceptions of care quality for providers integrating telemedicine into their practice.
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Affiliation(s)
- Kevin Wiley
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ashley Pugh
- National Committee for Quality Assurance, Washington, District of Columbia, USA
| | - Brittany L Brown-Podgorski
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joanna R Jackson
- Department of Management and Marketing College of Business Administration, Winthrop University, Rock Hill, South Carolina, USA
| | - David McSwain
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Rishworth A, King B, Holmes LM. Digital geographies of care: Telehealth landscapes of addiction treatment during the COVID-19 pandemic. Health Place 2024; 89:103296. [PMID: 38917673 DOI: 10.1016/j.healthplace.2024.103296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 03/23/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
The COVID-19 pandemic has created new digital health care landscapes for the management of substance use and misuse. While telehealth was prohibited for addiction treatment prior to the pandemic, the severity of COVID-19 precipitated telehealth expansion for the delivery of individual and group-based treatment. Research has highlighted benefits and challenges of telehealth; however, little is known about the impacts of telehealth on the quality, use, and effectiveness of treatment. Fewer studies examine how these emerging digital geographies of care transform the spaces and landscapes of substance misuse. This article examines how telehealth affects landscapes of opioid use disorder care in Pennsylvania, West Virginia, and Kentucky during the COVID-19 pandemic. Our findings reveal that while telehealth extends access to treatment for opioid use disorder (OUD), it also creates new care inequities within and between providers and clientele that can undermine effective care and recovery.
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Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, Mississauga, Ontario, Canada.
| | - Brian King
- Department of Geography, The Pennsylvania State University, State College, University Park, PA, United States.
| | - Louisa M Holmes
- Department of Geography, The Pennsylvania State University, State College, University Park, PA, United States.
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5
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Watkins VJ, Shee AW, Field M, Alston L, Hills D, Albrecht SL, Ockerby C, Hutchinson AM. Rural healthcare workforce preparation, response, and work during the COVID-19 pandemic in Australia: Lessons learned from in-depth interviews with rural health service leaders. Health Policy 2024; 145:105085. [PMID: 38820760 DOI: 10.1016/j.healthpol.2024.105085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Low population density, geographic spread, limited infrastructure and higher costs are unique challenges in the delivery of healthcare in rural areas. During the COVID-19 pandemic, emergency powers adopted globally to slow the spread of transmission of the virus included population-wide lockdowns and restrictions upon movement, testing, contact tracing and vaccination programs. The aim of this research was to document the experiences of rural health service leaders as they prepared for the emergency pandemic response, and to derive from this the lessons learned for workforce preparedness to inform recommendations for future policy and emergency planning. METHODOLOGY AND METHODS Interviews were conducted with leaders from two rural public health services in Australia, one small (500 staff) and one large (3000 staff). Data were inductively coded and analysed thematically. PARTICIPANTS Thirty-three participants included health service leaders in executive, clinical, and administrative roles. FINDINGS Six major themes were identified: Working towards a common goal, Delivery of care, Education and training, Organizational governance and leadership, Personal and psychological impacts, and Working with the Local Community. Findings informed the development of a applied framework. CONCLUSION The study findings emphasise the critical importance of leadership, teamwork and community engagement in preparing the emergency pandemic response in rural areas. Informed by this research, recommendations were made to guide future rural pandemic emergency responses or health crises around the world.
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Affiliation(s)
- Vanessa J Watkins
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety in the Institute for Health Transformation, Geelong, Victoria Australia.
| | - Anna Wong Shee
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Michael Field
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia; Western Alliance Academic Health Science Centre, Geelong, Victoria, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Danny Hills
- Federation University Australia, Health Innovation and Transformation Centre, Ballarat, Victoria, Australia
| | - Simon L Albrecht
- Deakin University, School of Psychology, Burwood, Victoria, Australia
| | | | - Alison M Hutchinson
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety in the Institute for Health Transformation, Geelong, Victoria Australia; Barwon Health, Geelong, Victoria, Australia
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6
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Lee M, Tsai MH, Tillewein H, Luckey GS. Rural-Urban Disparities in Telemedicine Use Among U.S. Adults with Cancer. Telemed J E Health 2024; 30:1539-1548. [PMID: 38301205 DOI: 10.1089/tmj.2023.0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Introduction: The COVID-19 pandemic has resulted in significant changes in health care delivery worldwide, including the widespread adoption of telemedicine. This study examines the prevalence of telemedicine use among cancer survivors in the United States based on rurality and investigates its association with telemedicine use. Methods: The 2021 National Health Interview Survey was used to analyze telemedicine use among cancer survivors during the pandemic. Telemedicine use was the primary outcome, and rurality was the main exposure. Descriptive statistics and multiple logistic regression models were used to examine the association. Results: Out of 27,500 eligible cancer survivors, 51.6% reported using telemedicine in 2021. Telemedicine usage varied across rural areas, with 41.4% of rural cancer survivors using telemedicine compared with 57.5% of cancer survivors in large metropolitan areas (p < 0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared with large metropolitan cancer survivors. Cancer survivors residing in rural areas were 0.56 times less likely (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.41-0.75), and those residing in medium and small metropolitan areas were 0.69 times less likely (OR = 0.69; 95% CI = 0.56-0.86) to report telemedicine use compared with cancer survivors in large metropolitan areas. Conclusions: Substantial disparities in telemedicine use were observed between rural and urban areas among cancer survivors. Rural cancer survivors were less likely to utilize telemedicine during the COVID-19 pandemic. Ensuring equitable access to telemedicine requires continued reimbursement for telemedicine services, along with additional efforts to improve access to and utilization of health care for rural cancer survivors.
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Affiliation(s)
- Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Simmons Cancer Institute at Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Meng-Han Tsai
- Georgia Prevention Institute, Augusta University, Augusta, Georgia, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Heather Tillewein
- Department of Health and Human Performance, Austin Peay State University, Clarksville, Tennessee, USA
| | - Georgia S Luckey
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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7
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O'Shea AMJ, Gibson M, Merchant J, Rewerts K, Miell K, Kaboli PJ, Shimada SL. Understanding rural-urban differences in veterans' internet access, use and patient preferences for telemedicine. J Rural Health 2024; 40:438-445. [PMID: 37935649 DOI: 10.1111/jrh.12805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The expansion of telemedicine (e.g., telephone or video) in the Veterans Health Administration (VA) raises concerns for health care disparities between rural and urban veterans. Factors impeding telemedicine use (e.g., broadband, digital literacy, age) disproportionally affect rural veterans. PURPOSE To examine veteran-reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality. METHODS Three hundred fifty veterans with a VA primary care visit in March 2022 completed a 30-min computer-assisted telephone interview. The sampling design stratified veterans by residential rurality (i.e., rural or urban) and how primary care was delivered (i.e., in-person or by video). Counts and weighted percentages are reported. FINDINGS After accounting for survey weights, 96.2% of respondents had in-home internet access and 89.5% reported functional connection speeds. However, rural- compared to urban-residing veterans were less likely to experience a telemedicine visit in the past year (74.1% vs. 85.2%; p = 0.02). When comparing telemedicine to in-person visits, rural versus urban-residing veterans rated them not as good (45.3% vs. 36.8%), just as good (51.1% vs. 53.1%), or better (3.5% vs. 10.0%) (p = 0.05). To make telemedicine visits easier, veterans, regardless of where they lived, recommended technology training (46.4%), help accessing the internet (26.1%), or provision of an internet-enabled device (25.9%). CONCLUSIONS Though rural-residing veterans were less likely to experience a telemedicine visit, the same actionable facilitators to improve telemedicine access were reported regardless of residential rurality. Importantly, technology training was most often recommended. Policy makers, patient advocates, and other stakeholders should consider novel initiatives to provide training resources.
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Affiliation(s)
- Amy M J O'Shea
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Mikayla Gibson
- Department of Human Physiology, University of Iowa College of Liberal Arts and Sciences, Iowa City, Iowa, USA
| | - James Merchant
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Kelby Rewerts
- Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Kelly Miell
- Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Peter J Kaboli
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), The Bedford VA Medical Center, Bedford, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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8
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Crowe J, Nikolic-Khatatbeh J, Li R. The digital health divide: Understanding telehealth adoption across racial lines in rural Illinois. SSM Popul Health 2024; 26:101665. [PMID: 38577064 PMCID: PMC10992690 DOI: 10.1016/j.ssmph.2024.101665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/12/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
Due to long-standing barriers to healthcare access in rural areas, telehealth has been promoted as an effective means of delivering healthcare services. However, there is a general absence of quantitative data showing how geographic residence and race affect telehealth adoption. This study examines variations in telehealth adoption based on race and geographic residence in Southern Illinois using a mail survey. It finds that residents of urban Carbondale, compared to those in rural Cairo, have better access to broadband and are more likely to use telehealth. Respondents significantly differ from each other based on their geographic location of residence and race when it came to using telehealth to save money on travel and to save money on childcare. A significant barrier to telehealth adoption identified across all groups is privacy protection concern. The findings highlight the crucial role of broadband infrastructure in healthcare access and the need for trust in telehealth systems to ensure data privacy.
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Affiliation(s)
- Jessica Crowe
- Economic Research Service, U.S. Department of Agriculture, Washington D.C, USA
| | - Jelena Nikolic-Khatatbeh
- School of Anthropology, Political Science, and Sociology, Southern Illinois University, Carbondale, IL, 62901, USA
| | - Ruopu Li
- School of Earth Systems and Sustainability, Southern Illinois University, Carbondale, IL, 62901, USA
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9
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Yousufuddin M, Mahmood M, Barkoudah E, Badr F, Khandelwal K, Manyara W, Sharma U, Abdalrhim AD, Issa M, Bhagra S, Murad MH. Rural-urban Differences in Long-term Mortality and Readmission Following COVID-19 Hospitalization, 2020 to 2023. Open Forum Infect Dis 2024; 11:ofae197. [PMID: 38698896 PMCID: PMC11065360 DOI: 10.1093/ofid/ofae197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
Background We compared long-term mortality and readmission rates after COVID-19 hospitalization based on rural-urban status and assessed the impact of COVID-19 vaccination introduction on clinical outcomes by rurality. Methods The study comprised adults hospitalized for COVID-19 at 17 hospitals in 4 US states between March 2020 and July 2022, followed until May 2023. The main analysis included all patients, whereas a sensitivity analysis focused on residents from 4 states containing 17 hospitals. Additional analyses compared the pre- and postvaccination periods. Results The main analysis involved 9325 COVID-19 hospitalized patients: 31% were from 187 rural counties in 31 states; 69% from 234 urban counties in 44 states; the mean age was 65 years (rural, 66 years; urban, 64 years); 3894 women (rural, 41%; urban, 42%); 8007 Whites (rural, 87%; urban, 83%); 1738 deaths (rural, 21%; urban, 17%); and 2729 readmissions (rural, 30%; urban, 29%). During a median follow-up of 602 days, rural residence was associated with a 22% higher all-cause mortality (log-rank, P < .001; hazard ratio, 1.22; 95% confidence interval, 1.10-1.34, P < .001), and a trend toward a higher readmission rate (log-rank, P = .038; hazard ratio, 1.06; 95% confidence interval, .98-1.15; P = .130). The results remained consistent in the sensitivity analysis and in both pre- and postvaccination time periods. Conclusions and Relevance Patients from rural counties experienced higher mortality and tended to be readmitted more frequently following COVID-19 hospitalization over the long term compared with those from urban counties, a difference that remained even after the introduction of COVID-19 vaccines.
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Affiliation(s)
- Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Maryam Mahmood
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ebrahim Barkoudah
- Department of Internal Medicine/Hospital Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fatimazahra Badr
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Warren Manyara
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Umesh Sharma
- Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Ahmed D Abdalrhim
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Meltiady Issa
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sumit Bhagra
- Department of Endocrine and Metabolism, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Hirani R, Noruzi K, Khuram H, Hussaini AS, Aifuwa EI, Ely KE, Lewis JM, Gabr AE, Smiley A, Tiwari RK, Etienne M. Artificial Intelligence and Healthcare: A Journey through History, Present Innovations, and Future Possibilities. Life (Basel) 2024; 14:557. [PMID: 38792579 PMCID: PMC11122160 DOI: 10.3390/life14050557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
Artificial intelligence (AI) has emerged as a powerful tool in healthcare significantly impacting practices from diagnostics to treatment delivery and patient management. This article examines the progress of AI in healthcare, starting from the field's inception in the 1960s to present-day innovative applications in areas such as precision medicine, robotic surgery, and drug development. In addition, the impact of the COVID-19 pandemic on the acceleration of the use of AI in technologies such as telemedicine and chatbots to enhance accessibility and improve medical education is also explored. Looking forward, the paper speculates on the promising future of AI in healthcare while critically addressing the ethical and societal considerations that accompany the integration of AI technologies. Furthermore, the potential to mitigate health disparities and the ethical implications surrounding data usage and patient privacy are discussed, emphasizing the need for evolving guidelines to govern AI's application in healthcare.
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Affiliation(s)
- Rahim Hirani
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
- Graduate School of Biomedical Sciences, New York Medical College, Valhalla, NY 10595, USA
| | - Kaleb Noruzi
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
| | - Hassan Khuram
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA
| | - Anum S. Hussaini
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Esewi Iyobosa Aifuwa
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
| | - Kencie E. Ely
- Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89106, USA
| | - Joshua M. Lewis
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
| | - Ahmed E. Gabr
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
| | - Abbas Smiley
- School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Raj K. Tiwari
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
- Graduate School of Biomedical Sciences, New York Medical College, Valhalla, NY 10595, USA
| | - Mill Etienne
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA; (R.H.)
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
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11
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Ternes S, Lavin L, Vakkalanka JP, Healy HS, Merchant KA, Ward MM, Mohr NM. The role of increasing synchronous telehealth use during the COVID-19 pandemic on disparities in access to healthcare: A systematic review. J Telemed Telecare 2024:1357633X241245459. [PMID: 38646804 DOI: 10.1177/1357633x241245459] [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: 04/23/2024]
Abstract
INTRODUCTION The COVID-19 public health emergency led to an unprecedented rapid increase in telehealth use, but the role of telehealth in reducing disparities in access to care has been questioned. The objective of this study was to conduct a systematic review to summarize the available evidence on how telehealth during the COVID-19 pandemic was associated with telehealth utilization for minority groups and its role in health disparities. METHODS We conducted a systematic review focused on health equity and access to care by searching for interventional and observational studies using the following four search domains: telehealth, COVID-19, health equity, and access to care. We searched PubMed, Embase, Cochrane CENTRAL, CINAHL, telehealth.hhs.gov, and the Rural Health Research Gateway, and included any study that reported quantitative results with a control group. RESULTS Our initial search yielded 1970 studies, and we included 48 in our final review. The most common dimensions of health equity studied were race/ethnicity, rurality, insurance status, language, and socioeconomic status, and the telehealth applications studied were diverse. Included studies had a moderate risk of bias. In aggregate, most studies reported increased telehealth use during the pandemic, with the greatest increase in non-minority populations, including White, younger, English-speaking people from urban areas. DISCUSSION We found that despite rapid adoption and increased telehealth use during the public health emergency, telehealth did not reduce existing disparities in access to care. We recommend that future work measuring the impact of telehealth focus on equity so that features of telehealth innovation can reduce disparities in health outcomes.
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Affiliation(s)
- Sara Ternes
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Lauren Lavin
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
| | - J Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Heather S Healy
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, IA, USA
| | - Kimberly As Merchant
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
- Department of Anesthesia Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Tierney AA, Mosqueda M, Cesena G, Frehn JL, Payán DD, Rodriguez HP. Telemedicine Implementation for Safety Net Populations: A Systematic Review. Telemed J E Health 2024; 30:622-641. [PMID: 37707997 PMCID: PMC10924064 DOI: 10.1089/tmj.2023.0260] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
Background: Telemedicine systems were rapidly implemented in response to COVID-19. However, little is known about their effectiveness, acceptability, and sustainability for safety net populations. This study systematically reviewed primary care telemedicine implementation and effectiveness in safety net settings. Methods: We searched PubMed for peer-reviewed articles on telemedicine implementation from 2013 to 2021. The search was done between June and December 2021. Included articles focused on health care organizations that primarily serve low-income and/or rural populations in the United States. We screened 244 articles from an initial search of 343 articles and extracted and analyzed data from N = 45 articles. Results: Nine (20%) of 45 articles were randomized controlled trials. N = 22 reported findings for at least one marginalized group (i.e., racial/ethnic minority, 65 years+, limited English proficiency). Only n = 19 (42%) included African American/Black patients in demographics descriptions, n = 14 (31%) LatinX/Hispanic patients, n = 4 (9%) Asian patients, n = 4 (9%) patients aged 65+ years, and n = 4 (9%) patients with limited English proficiency. Results show telemedicine can provide high-quality primary care that is more accessible and affordable. Fifteen studies assessed barriers and facilitators to telemedicine implementation. Common barriers were billing/administrative workflow disruption (n = 9, 20%), broadband access/quality (n = 5, 11%), and patient preference for in-person care (n = 4, 9%). Facilitators included efficiency gains (n = 6, 13%), patient acceptance (n = 3, 7%), and enhanced access (n = 3, 7%). Conclusions: Telemedicine is an acceptable care modality to deliver primary care in safety net settings. Future studies should compare telemedicine and in-person care quality and test strategies to improve telemedicine implementation in safety net settings.
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Affiliation(s)
- Aaron A. Tierney
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Mariana Mosqueda
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Gabriel Cesena
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Jennifer L. Frehn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Denise D. Payán
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, California, USA
| | - Hector P. Rodriguez
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Lee JS, Bhatt A, Jackson SL, Pollack LM, Omeaku N, Beasley KL, Wilson C, Luo F, Roy K. Rural and Urban Differences in Hypertension Management Through Telehealth Before and During the COVID-19 Pandemic Among Commercially Insured Patients. Am J Hypertens 2024; 37:107-111. [PMID: 37772661 PMCID: PMC10900132 DOI: 10.1093/ajh/hpad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic prompted a rapid increase in telehealth use. However, limited evidence exists on how rural and urban residents used telehealth and in-person outpatient services to manage hypertension during the pandemic. METHODS This longitudinal study analyzed 701,410 US adults (18-64 years) in the MarketScan Commercial Claims Database, who were continuously enrolled from January 2017 through March 2022. We documented monthly numbers of hypertension-related telehealth and in-person outpatient visits (per 100 individuals), and the proportion of telehealth visits among all hypertension-related outpatient visits, from January 2019 through March 2022. We used Welch's two-tail t-test to differentiate monthly estimates by rural-urban status and month-to-month changes. RESULTS From February through April 2020, the monthly number of hypertension-related telehealth visits per 100 individuals increased from 0.01 to 6.05 (P < 0.001) for urban residents and from 0.01 to 4.56 (P < 0.001) for rural residents. Hypertension-related in-person visits decreased from 20.12 to 8.30 (P < 0.001) for urban residents and from 20.48 to 10.15 (P < 0.001) for rural residents. The proportion of hypertension-related telehealth visits increased from 0.04% to 42.15% (P < 0.001) for urban residents and from 0.06% to 30.98% (P < 0.001) for rural residents. From March 2020 to March 2022, the monthly average of the proportions of hypertension-related telehealth visits was higher for urban residents than for rural residents (10.19% vs. 6.96%; P < 0.001). CONCLUSIONS Data show that rural residents were less likely to use telehealth for hypertension management. Understanding trends in hypertension-related telehealth utilization can highlight disparities in the sustained use of telehealth to advance accessible health care.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami Bhatt
- Applied Science, Research, and Technology Inc. (ASRT Inc.), Atlanta, Georgia, USA
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nina Omeaku
- Applied Science, Research, and Technology Inc. (ASRT Inc.), Atlanta, Georgia, USA
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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14
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Cook N, McGrath BM, Navale SM, Koroukian SM, Templeton AR, Crocker LC, Zyzanski SJ, Bensken WP, Stange KC. Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022). J Am Board Fam Med 2024; 36:916-926. [PMID: 37857445 PMCID: PMC10843627 DOI: 10.3122/jabfm.2023.230081r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery. OBJECTIVE To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE). METHODS We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states. RESULTS There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022. CONCLUSION Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.
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Affiliation(s)
- Nicole Cook
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS).
| | - Brenda M McGrath
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Suparna M Navale
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Siran M Koroukian
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Anna R Templeton
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Laura C Crocker
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Stephen J Zyzanski
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Wyatt P Bensken
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Kurt C Stange
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
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Holderness H, Baron A, Hodes T, Marino M, O’Malley J, Danna M, Cohen DJ, Huguet N. Community Health Centers Uptake of Telemedicine During the COVID-19 Pandemic: Trends, Barriers, and Successful Strategies. J Prim Care Community Health 2024; 15:21501319241274351. [PMID: 39183703 PMCID: PMC11345735 DOI: 10.1177/21501319241274351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE To describe telemedicine use patterns and understand clinic's approaches to shifting care delivery during the COVID-19 pandemic. METHODS We used electronic health record data from 203 community health centers across 13 states between 01/01/2019 and 6/31/2021 to describe trends in telemedicine visit rates over time. Qualitative data were collected from 13 of those community health centers to understand factors influencing adoption and implementation of telemedicine. RESULTS Most clinics in our sample were in urban areas (n = 176) and served a majority of uninsured and publicly insured patients (12.8% and 44.4%, respectively) across racial and ethnic minority groups (16.6% Black and 29.3% Hispanic). During our analysis period there was a 791% increase in telemedicine visits from before the pandemic (.06% pre- vs 47.5% during). A latent class growth analysis was used to examine differences in patterns of adoption of telemedicine across the 203 CHCs. The model resulted in 6 clusters representing various levels of telemedicine adoption. A mixed methods approach streamlined these clusters into 4 final groups. Clinics that reported rapid adoption of telemedicine attributed this change to leadership prioritization of telemedicine, robust quality improvement processes (eg, using PDSA processes), and emphasis on training and technology support. CONCLUSIONS In response to the COVID-19 pandemic, telemedicine adoption rates varied across clinics. Our study highlight that organizational factors contributed to the clinic's ability to rapidly uptake and use telemedicine services throughout the pandemic. These approaches could inform future non-pandemic practice change and care delivery.
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Affiliation(s)
| | - Andrea Baron
- Oregon Health & Science University, Portland, OR, USA
| | - Tahlia Hodes
- Oregon Health & Science University, Portland, OR, USA
| | - Miguel Marino
- Oregon Health & Science University, Portland, OR, USA
| | | | - Maria Danna
- Oregon Health & Science University, Portland, OR, USA
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Kluger BM, Katz M, Galifianakis NB, Pantilat SZ, Hauser JM, Khan R, Friedman C, Vaughan CL, Goto Y, Long SJ, Martin CS, Dini M, McQueen RB, Palmer L, Fairclough D, Seeberger LC, Sillau SH, Kutner JS. Patient and Family Outcomes of Community Neurologist Palliative Education and Telehealth Support in Parkinson Disease. JAMA Neurol 2024; 81:39-49. [PMID: 37955923 PMCID: PMC10644250 DOI: 10.1001/jamaneurol.2023.4260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/29/2023] [Indexed: 11/14/2023]
Abstract
Importance Parkinson disease and related disorders (PDRD) are the fastest growing neurodegenerative illness in terms of prevalence and mortality. As evidence builds to support palliative care (PC) for PDRD, studies are needed to guide implementation. Objective To determine whether PC training for neurologists and remote access to a PC team improves outcomes in patients with PDRD in community settings. Design, Setting, and Participants This pragmatic, stepped-wedge comparative effectiveness trial enrolled and observed participants from 19 community neurology practices supported by PC teams at 2 academic centers from March 8, 2017, to December 31, 2020. Participants were eligible if they had PDRD and moderate to high PC needs. A total of 612 persons with PDRD were referred; 253 were excluded. Patients were excluded if they had another diagnosis meriting PC, were receiving PC, or were unable or unwilling to follow study procedures. Patients received usual care or the intervention based on when their community neurologist was randomized to start the intervention. Data were analyzed from January 2021 to September 2023. Intervention The intervention included (1) PC education for community neurologists and (2) team-based PC support via telehealth. Main Outcomes and Measures The primary outcomes were differences at 6 months in patient quality of life (QOL; measured by the Quality of Life in Alzheimer Disease Scale [QOL-AD]) and caregiver burden (Zarit Burden Interview) between the intervention and usual care. Results A total of 359 patients with PDRD (233 men [64.9%]; mean [SD] age, 74.0 [8.8] years) and 300 caregivers were enrolled. At 6 months, compared with usual care, participants receiving the intervention had better QOL (QOL-AD score, 0.09 [95% CI, -0.63 to 0.82] vs -0.88 [95% CI, -1.62 to -0.13]; treatment effect estimate, 0.97; 95% CI, 0.07-1.86; P = .03). No significant difference was observed in caregiver burden (Zarit Burden Interview score, 1.19 [95% CI, 0.16 to 2.23] vs 0.55 [95%, -0.44 to 1.54]; treatment effect estimate, 0.64; 95% CI, -0.62 to 1.90; P = .32). Advance directive completion was higher under the intervention (19 of 38 [50%] vs 6 of 31 [19%] among those without directives at the beginning of the study; P = .008). There were no differences in other outcomes. Conclusions and Relevance PC education for community neurologists and provision of team-based PC via telehealth is feasible and may improve QOL and advance care planning. Overall treatment effects were small and suggest opportunities to improve both the intervention and implementation. Trial Registration ClinicalTrials.gov Identifier: NCT03076671.
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Affiliation(s)
- Benzi M. Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Maya Katz
- Department of Neurology, Stanford University, Stanford, California
| | | | - Steven Z. Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco
| | - Joshua M. Hauser
- Division of Palliative Medicine, Department of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Ryan Khan
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora
| | - Cari Friedman
- Parkinson Association of the Rockies, University of Denver, Denver, Colorado
| | | | - Yuika Goto
- Department of Palliative Care, University of California, San Francisco
| | - S. Judith Long
- Department of Palliative Care, University of California, San Francisco
| | | | - Megan Dini
- Parkinson’s Foundation, Denver, Colorado
| | - R. Brett McQueen
- Department of Clinical Pharmacy, University of Colorado School of Medicine, Aurora
| | - Laura Palmer
- Quality and Process Improvement, University of Colorado School of Medicine, Aurora
| | - Diane Fairclough
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora
| | - Lauren C. Seeberger
- Department of Neurology, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia
| | - Stefan H. Sillau
- Department of Neurology, School of Public Health, University of Colorado, Aurora
| | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora
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Pullyblank K, Krupa N, Scribani M, Chapman A, Kern M, Brunner W. Trends in telehealth use among a cohort of rural patients during the COVID-19 pandemic. Digit Health 2023; 9:20552076231203803. [PMID: 37799503 PMCID: PMC10548799 DOI: 10.1177/20552076231203803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
Objective Rural populations faced unique challenges to healthcare access during the COVID-19 pandemic. This analysis assesses trends in digital health technology use at the onset of the pandemic and describes digital health behaviors among a cohort of patients within a rural integrated healthcare network throughout the first 3 years of the pandemic. Methods We used data from both the electronic health record (EHR) and a patient survey. EHR data was used to longitudinally assess change over time in patient portal use and telehealth visits. Survey responses were used to provide additional context. Results Telehealth appointments peaked in the first quarter of 2020 at 28% of all office visits, before leveling off to 8-10% in 2022. Women and those younger than 65 were more likely to have participated in telehealth appointments. Active patient portal users increased from 34.1% in January 2019 to 63.7% in January 2022. There were no differences noted in portal use trends based on rurality. Conclusions Our findings corroborate previous research, as well as add context regarding digital health technology use throughout the COVID pandemic in a rural patient population. Future research must focus on understanding constraints to digital health expansion in order to continue providing safe, equitable care.
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Affiliation(s)
- Kristin Pullyblank
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY, USA
| | - Nicole Krupa
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY, USA
| | - Melissa Scribani
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY, USA
| | - Amanda Chapman
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY, USA
| | - Megan Kern
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY, USA
| | - Wendy Brunner
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY, USA
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