Administrative Core

行政核心

• 批准号: 10211062
• 负责人: CONSUELO HOPKINS WILKINS
• 金额: $ 21.12万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-19 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10211062
• 关键词: Accounting; Administrative Supplement; Adult; Affect; African American; Asthma; COVID-19; COVID-19 pandemic; Caring; Cessation of life; Chicago; Child; Child health care; Childhood; Cities; Clinic; Code; Data; Distant; Emergency Situation; Ensure; Ethnic Origin; Family; Foundations; Future; Guidelines; Health; Healthcare; Home environment; Hospitalization; Human; Internet; Knowledge; Language; Length; Low income; Measures; Medicaid; Medical; Minority; Minority Groups; Modality; Modification; New York; Participant; Patient Care; Patients; Physicians; Policies; Population; Population Heterogeneity; Primary Health Care; Privacy; Probability; Process; Provider; Race; Regulation; Sampling; Services; Societies; Surveys; Technology; Telemedicine; Telephone; Tennessee; Testing; Time; Traction; Trust; Underrepresented Minority; Underserved Population; United States Dept. of Health and Human Services; Visit; Vulnerable Populations; Work; demographics; design; ethnic diversity; health care availability; health care delivery; health care service utilization; health disparity; interest; literacy; pandemic disease; pediatric patients; personalized approach; population health; precision medicine; prospective; provider-level barriers; racial diversity; satisfaction; service delivery; social; social health determinants; telehealth; uptake

The COVID-19 pandemic is not affecting everyone equally. In Nashville, Tennessee, the number of confirmed COVID-19 cases are higher in ZIP Code regions that are burdened by poorer social determinants of health and higher rates of conditions such as asthma. To allow for safe, effective, and physically distant care, telemedicine has emerged as a modality for preferred health care delivery. However, telemedicine requires access to technology, broadband internet access, technologic literacy, and in many cases, English proficiency. These are often inaccessible to vulnerable populations who, additionally, may have privacy concerns and be less trusting of telemedicine. Now that the Health and Human Services (HHS) guidelines for telemedicine are relaxed, creating greater ease for lower income diverse populations to access this modality from their home, it must be built to ensure access equity that allows for a more precise tailored approach. Despite indications that children are less often infected with COVID-19 than adults, utilization of overall child health care has decreased substantially since the pandemic gained traction with physical distancing requirements, but the use of telemedicine in children has not increased. This is especially true if those children are from underrepresented minority populations. We propose an administrative supplement to understand what makes telemedicine feasible and acceptable in underserved populations. In Aim 1, we will randomly select Vanderbilt Pediatric Primary Care patients who live in ZIP Code regions reflective of racially and ethnic diverse patient families with higher social needs (N=500) and measure retrospective telemedicine utilization during the early period of the COVID-19 pandemic (from March 1- June 30, 2020). We will conduct a 30-60 minute telephonic survey in the participant language of choice (English, Spanish, or Arabic) to assess telemedicine utilization, knowledge, interest, accounting for social determinants of health, COVID-19 impact, technology access, race/ethnicity, and patient trust. We will then use the knowledge gained to prospectively design and test modified telemedicine approaches, assessing the feasibility and acceptability of telemedicine visits provided to 100 low-income pediatric patients (50 English and 50 non-English). Process data collected will include selected telemedicine platform (of the HHS accepted choices), visit length, and patient-family and provider satisfaction. Qualitative data collected will identify both patient-family and provider barriers and facilitators. These data will inform policies and processes to create equitable telehealth approaches for diverse pediatric populations.

COVID-19 大流行并没有平等地影响每个人。在田纳西州纳什维尔，确诊人数 邮政编码地区的 COVID-19 病例较高，这些地区的健康和社会决定因素较差 哮喘等疾病的发病率较高。为了提供安全、有效和远程护理， 远程医疗已成为首选医疗保健提供方式。然而，远程医疗需要 获得技术、宽带互联网接入、技术素养，以及在许多情况下，英语水平。 这些往往是弱势群体无法访问的，此外，他们可能有隐私问题并被 对远程医疗的信任度降低。现在，健康与公众服务部 (HHS) 的远程医疗指南已发布 放松，为低收入多样化人群在家中使用这种方式创造了更大的便利， 必须建立确保准入公平性的机制，以便采取更精确的定制方法。尽管有迹象表明 与成人相比，儿童感染 COVID-19 的几率较低，总体儿童医疗保健的利用率有所提高 自从大流行病引起人们对保持身体距离的要求以来，使用率大幅下降，但使用 儿童远程医疗的数量并没有增加。如果这些儿童来自代表性不足的少数族裔群体，情况尤其如此。我们提出行政补充，以了解是什么让 远程医疗在服务不足的人群中可行且可接受。在目标 1 中，我们将随机选择 Vanderbilt 居住在反映种族和民族多样性的邮政编码地区的儿科初级保健患者 社会需求较高的家庭 (N=500) 并衡量早期远程医疗的使用情况 COVID-19 大流行期间（2020 年 3 月 1 日至 6 月 30 日）。我们将进行 30-60 分钟的电话咨询 以参与者选择的语言（英语、西班牙语或阿拉伯语）进行调查，以评估远程医疗的利用情况， 知识、兴趣、健康的社会决定因素、COVID-19 影响、技术获取、 种族/民族和患者信任。然后，我们将利用获得的知识进行前瞻性设计和测试 修改远程医疗方法，评估远程医疗就诊的可行性和可接受性 100 名低收入儿科患者（50 名英国人和 50 名非英国人）。收集的过程数据将包括选定的 远程医疗平台（HHS 接受的选择）、就诊时长以及患者家属和提供者满意度。 收集的定性数据将确定患者家属和提供者的障碍和促进因素。这些数据将 为政策和流程提供信息，为不同的儿科人群创建公平的远程医疗方法。