Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19
Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19
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DOI：
10.1093/jamia/ocaa217
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发表时间：
2021-01-01
影响因子：
6.4
通讯作者：
Mann, Devin M.
中科院分区：
文献类型：
--
作者：
Chunara, Rumi;Zhao, Yuan;Mann, Devin M.
目的：通过2019年冠状病毒病（COVID-19）大流行，远程医疗成为诊断、分诊和治疗过程的必要切入点。在COVID-19中，关于感染风险和入院后的住院结局，医疗保健中的种族和民族差异已有很好的记录，在这里，我们评估了通过远程医疗获得COVID-19医疗保健的人的差异。材料和方法：3月19日至4月30日期间纽约大学朗格尼健康中心患者的电子健康记录数据，使用2020年的数据对访视类型进行描述性和多水平回归分析结果：控制个人和社区层面的属性，黑人患者的调整后几率为0.6倍，与白色患者相比，通过远程医疗获得护理的比例（95% CI：0.58-0.63），尽管在年轻女性人群的推动下，越来越多的白人患者通过远程医疗获得紧急护理。COVID诊断黑人与白色远程医疗patients.Discussion相比明显更有可能：黑人患者访问远程医疗存在差异，但年轻女性黑人患者的使用率增加。平均收入和平均家庭规模下降的邮政编码也显着相关的远程医疗use.Conclusion：远程医疗访问的差距反映了那些在人的医疗服务。不同用途的根源是复杂的，反映了个人，社区和结构因素，包括它们的交叉，其中许多是由于系统的种族主义。关于通过远程医疗表现出的差距的证据可用于为工具设计和系统努力提供信息，以促进数字健康公平。
Objective: Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage, and treatment. Racial and ethnic disparities in healthcare have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19.Materials and Methods: Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis, and COVID test results.Results: Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95% CI: 0.58-0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients.Discussion: There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of a zip code were also significantly related to telemedicine use.Conclusion: Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection-many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity.