Department of Medicine, Hennepin Healthcare, and University of Minnesota, Minneapolis, Minnesota, United States.
Analytics Center of Excellence, Hennepin Healthcare, Minneapolis, Minnesota, United States.
Appl Clin Inform. 2022 May;13(3):612-620. doi: 10.1055/s-0042-1749597. Epub 2022 Jun 8.
During the coronavirus disease 2019 pandemic, as a safety-net organization with a substantial percentage of patients of color and with limited English proficiency (LEP), we were wary of furthering health disparities in our community. We analyzed gaps in telemedicine (telephone and video) delivery in our communities, quantified the effects of our tests of change, and began the process of accumulating evidence to create a road map for other organizations.
We leveraged Lean problem-solving strategies to identify modifiable gaps across multiple domains that could inhibit equity in telemedicine. We implemented tests of change across domains of community engagement, technology, education, and access. We observed the proportion of telemedicine encounters across races and languages between April and November, 2020. Regression analyses tested the impact of race and language on telemedicine controlling for age, gender, insurance, and time.
Several rounds of changes and enhancements were associated with changes in telemedicine use of +5.5% ( < 0.0001) for Hispanic, +4.0% ( < 0.0001) for Spanish-speaking, -2.1% for Black ( < 0.05), and -4.4% for White patients ( < 0.001). African-American, Hispanic, and non-English-speaking patients had between 2.3 and 4.6 times the odds of preferring telephone to video encounters ( < 0.0001), with increases in preferences for video use over time ( < 0.05).
Our roadmap to improve equitable delivery of telemedicine was associated with a significant improvement in telemedicine use among certain minority populations. Most populations of color used telephone more often than video. This preference changed over time and with equity-focused changes in telemedicine delivery.
在 2019 年冠状病毒病大流行期间，作为一个拥有大量有色人种患者和有限英语水平（LEP）患者的安全网组织，我们担心会在我们的社区中进一步扩大健康差距。我们分析了我们社区远程医疗（电话和视频）提供方面的差距，量化了我们变革测试的效果，并开始积累证据，为其他组织创建路线图。
我们利用精益问题解决策略来确定可能阻碍远程医疗公平性的多个领域中的可修改差距。我们在社区参与、技术、教育和准入领域实施了变革测试。我们观察了 2020 年 4 月至 11 月期间不同种族和语言的远程医疗就诊比例。回归分析测试了种族和语言对远程医疗的影响，同时控制了年龄、性别、保险和时间。
几轮变革和改进与远程医疗使用的变化相关，西班牙语裔患者的使用率增加了 5.5%（ < 0.0001），西班牙语患者的使用率增加了 4.0%（ < 0.0001），黑人和白人患者的使用率分别下降了 2.1%（ < 0.05）和 4.4%（ < 0.001）。非裔美国人、西班牙裔和非英语患者更喜欢电话而不是视频就诊的可能性是其他患者的 2.3 到 4.6 倍（ < 0.0001），随着时间的推移，他们对视频使用的偏好也有所增加（ < 0.05）。
我们改善远程医疗公平提供的路线图与某些少数族裔群体远程医疗使用率的显著提高有关。大多数有色人种群体更频繁地使用电话而不是视频。这种偏好随着时间的推移和远程医疗提供方面的公平性变革而发生变化。
