Center of Excellence in Precision Medicine and Population Health

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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.