Racial and Ethnic Disparities in Health Information Technology Use and Associated Trends among Individuals Living with Chronic Diseases

Development of a Hereditary Breast and Ovarian Cancer and Genetics Curriculum for Community Health Workers: KEEP IT (Keeping Each other Engaged Program via IT) Community Health Worker Training

We developed a curriculum for community health workers (CHWs) using an innovative, community-engaged focus group and Delphi process approach. Equipping CHWs with knowledge of hereditary breast and ovarian cancer syndrome (HBOC) and genetics could help enhance identification of women at risk for HBOC, referral, and navigation through genetic services. We conducted focus groups with five CHWs and a three-round Delphi process with eight experts. In the first round of the Delphi process, participants rated and commented on draft curriculum modules. The second round involved live video discussion to highlight points of confusion and concern in the modules. The curriculum was revised and refined based on quantitative and qualitative data and reassessed by the experts in Round 3. Ultimately, agreement was achieved on eight of 10 modules when assessing for clarity of learning objectives, seven out of 10 when assessing for adult learning theory, and nine out of 10 when assessing for participants' ability to learn desired knowledge. We plan to virtually deliver this curriculum to CHWs to enhance their HBOC and genomic competencies. By equipping CHWs to understand and participate in genomics education, we can enable more equitable participation in genomics-informed clinical care and research. Beyond this curriculum, the Delphi methodology can further be used to design content for new CHW curriculums.

Health Information Technology Use among Chronic Disease Patients: An Analysis of the United States Health Information National Trends Survey

BACKGROUND

Chronic disease is the leading cause of mortality in the United States. Health information technology (HIT) tools show promise for improving disease management.

OBJECTIVES

This study aims to understand the following: (1) how self-perceptions of health compare between those with and without disease; (2) how HIT usage varies between chronic disease profiles (diabetes, hypertension, cardiovascular disease, pulmonary disease, depression, cancer, and comorbidities); (3) how HIT trends have changed in the past 6 years; and (4) the likelihood that a given chronic disease patient uses specific HIT tools.

METHODS

The Health Information National Trends Survey (HINTS) inclusive of 2014 to 2020 served as the primary data source with statistical analysis completed using Stata. Bivariate analyses and two-tailed t-tests were conducted to compare self-perceived health and HIT usage to chronic disease. Logistic regression models were created to examine the odds of a specific patient using various forms of HIT, controlling for demographics and comorbidities.

RESULTS

Logistic regression models controlling for sociodemographic factors and comorbidities showed that pulmonary disease, depression, and cancer patients had an increased likelihood of using HIT tools, for example, depression patients had an 81.1% increased likelihood of looking up health information (p < 0.0001). In contrast, diabetic, high blood pressure, and cardiovascular disease patients appeared to use HIT tools at similar rates to patients without chronic disease. Overall HIT usage has increased during the timeframe examined.

CONCLUSION

This study demonstrates that certain chronic disease cohorts appear to have greater HIT usage than others. Further analysis should be done to understand what factors influence patients to utilize HIT which may provide additional insights into improving design and user experience for other populations with the goal of improving management of disease. Such analyses could also establish a new baseline to account for differences in HIT usage as a direct consequence of the novel coronavirus disease 2019 (COVID-19) pandemic.

Disparities in Telehealth Utilization in a Population of Publicly Insured Children During the COVID-19 Pandemic

Telehealth became a crucial vehicle for health care delivery in the United States during the COVID-19 pandemic. However, little research exists on inequities in telehealth utilization among the pediatric population. This study examines disparities in telehealth utilization in a population of publicly insured children. This observational, retrospective study used administrative data from Alabama's stand-alone Children's Health Insurance Program, ALL Kids. Rates of any telehealth use for March to December 2020 were examined. In addition-to capture lack of health care utilization-rates of having no medical claims were examined and compared with March to December 2019 and 2018. Multinomial logit models were estimated to investigate how telehealth use and having no medical claims (reference category: having medical claims but no telehealth) were associated with race/ethnicity, rural-urban residence, and family income. Of the 106,478 enrollees over March to December 2020, 13.4% had any telehealth use and 24.7% had no medical claims. The latter was greater than no medical claims in 2019 (19.5%) and 2018 (20.7%). Black and Hispanic children had lower odds of any telehealth use (odds ratio [OR]: 0.81, P < 0.01; OR: 0.68, P < 0.01) and higher odds of no medical claims (OR: 1.11, P < 0.05; OR: 1.73, P < 0.05) than non-Hispanic White children. Rural residents had lower odds of telehealth use than urban residents. Those in the highest family income-based fee group had higher odds of telehealth use than the lowest family income-based fee group. As telehealth will likely continue to play an important role in health care delivery, additional efforts/investments are required to ensure telehealth does not further exacerbate inequities in pediatric health care access.