TELE Para DM: Telemedicine Equity for Limited English Proficient Patients with Diabetes Mellitus in the Safety Net

项目总结/摘要 远程医疗（远程电话和视频健康访问）是一种数字健康工具，可以增加获得护理的机会 并改善健康状况。远程医疗护理对于在以下情况下维持医疗保健服务至关重要- 个人护理中断，冠状病毒-19疾病（COVID-19）大流行的到来迫使 几乎在一夜之间将远程医疗纳入护理。但这对安全网卫生系统来说是个问题， 不成比例地向少数种族/民族和英语水平有限（LEP）的患者提供护理，这些患者 面临着过去数字医疗技术的重大障碍。在这个K23，我们将研究远程医疗在洛杉矶 洛杉矶县卫生服务部（LAC DHS）-美国第二大安全网 States.我们将重点关注需要频繁间隔护理的特别脆弱人群： 糖尿病（DM），特别针对LEP西班牙语使用者，占LAC DM患者的62% 国土安全部本K23提案将调查影响远程医疗使用的因素的差异，并探索 通过西班牙语和英语之间的定量和定性分析， 初级保健患者（目标1）。与LAC DHS虚拟护理工作组合作， 分析将为西班牙语和英语的患者指导干预的定制设计提供信息， 和促进远程医疗的使用（目标2）和双语干预的试点随机对照试验（目标 3）。这些目标将通过混合方法、实施科学和数字健康差异来实现 概念框架，因为它们涉及NIMHD研究的优先领域，即制定干预措施， 改善弱势患者获得护理的机会，减少健康差距。这些研究是新颖的， 及时关注弱势患者群体的远程医疗实施，解决LEP患者 明确，以及建议使用混合方法来制定理论驱动的干预措施。拟议 研究以亚历杭德拉·卡西利亚斯博士作为初级保健医生的角色及其患者门户研究为基础 在不同的城市初级保健环境中的经验。卡西利亚斯博士的长期目标是开发干预措施， 减少数字健康差距，增加健康可及性，改善少数种族/族裔的健康结果 LEP患者在这个奖项的过程中，卡西利亚斯博士将进行教学和体验培训 提高三个领域的知识和技能：（1）数字健康差异研究的混合方法，（2） 安全网中的远程医疗服务，以及（3）在现实世界临床环境中对试点试验干预措施的评价 使用执行科学方法。卡西利亚斯博士组建了一个多机构指导团队， 补充专业知识，以确保完成拟议的研究和培训， 过渡到独立。这个K23将定位博士. Casillas，作为一个早期的职业研究者，开发一个 NIMHD-R 01用于其他语言和慢性疾病：研究结果可能导致广泛采用 这种模式作为一种基于证据的干预措施，以加强对美国弱势患者的远程医疗。

Project Summary/Abstract Telemedicine (remote telephone and video health visits) is a digital health tool that can increase access to care and improve health outcomes. Telemedicine care has been critical to maintaining healthcare access when in- person care is disrupted, and the arrival of the Coronavirus-19 disease (COVID-19) pandemic forced the integration of telemedicine into care almost overnight. But this is problematic for safety net health systems who disproportionately provide care to racial/ethnic minority and Limited English Proficient (LEP) patients, who have faced significant barriers with past digital health technology. In this K23, we will study telemedicine in the Los Angeles County Department of Health Services (LAC DHS)— the second largest safety net in the United States. We will focus on a particularly vulnerable population with need for frequent, interval care: patients with diabetes mellitus (DM), specifically addressing LEP Spanish-speakers, who are 62% of the DM patients at LAC DHS. This K23 proposal will investigate differences in factors affecting telemedicine use and explore associated quality of diabetic care via quantitative and qualitative analyses among Spanish- and English- speaking primary care patients (Aim 1). In partnership with the LAC DHS Virtual Care Workgroup, these analyses will inform the tailored design of a patient coaching intervention in Spanish and in English to increase and facilitate telemedicine use (Aim 2) and a pilot randomized controlled trial of the bilingual intervention (Aim 3). These aims will be achieved using mixed methods, implementation science, and digital health disparities conceptual frameworks as they address the NIMHD research priority areas of developing interventions to improve access to care for vulnerable patients and reduce health disparities. The studies are novel given the timely focus on telemedicine implementation for vulnerable patient populations, addressing LEP patients explicitly, as well as the proposed use of mixed methods to develop a theory-driven intervention. The proposed studies are informed by Dr. Alejandra Casillas’ role as a primary care physician and her patient portal research experience in diverse, urban primary care settings. Dr. Casillas’ long-term goal is to develop interventions that reduce digital health disparities, increase health access, and improve health outcomes for racial/ethnic minority and LEP patients. During the course of this award, Dr. Casillas will undertake didactic and experiential training to improve knowledge and skills in three areas: (1) mixed methods in digital health disparities research, (2) telemedicine delivery in the safety net, and (3) evaluation of pilot trial interventions in real-world clinical settings using implementation science methods. Dr. Casillas has assembled a multi-institutional mentorship team with the complementary expertise to ensure completion of the proposed research and training and successful transition to independence. This K23 will position Dr. Casillas, as an early career investigator, to develop a NIMHD-R01 for other languages and chronic disease conditions: findings could result in widespread adoption of this model as an evidence-based intervention to augment telemedicine for vulnerable patients in the US.