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

项目摘要/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保持医疗保健获取至关重要- 个人护理中断，冠状病毒-19型疾病(新冠肺炎)大流行的到来迫使 几乎在一夜之间将远程医疗整合到护理中。但这对安全网卫生系统来说是有问题的 向种族/少数民族和英语水平有限(LEP)患者提供不成比例的护理，这些患者有 过去的数字医疗技术面临着重大障碍。在这个K23课程中，我们将在洛杉矶学习远程医疗 洛杉矶县卫生服务部(LAC DHS)-美国第二大安全网 各州。我们将重点关注需要频繁间隔护理的特别脆弱的人群： 糖尿病(DM)，特别针对讲LEP西班牙语的人，他们占LAC糖尿病患者的62% 国土安全部。K23提案将调查影响远程医疗使用的因素的差异，并探索 通过在西班牙语和英语中进行定量和定性分析来评估糖尿病护理的相关质量 讲初级保健病人(目标1)。与LAC DHS虚拟护理工作组合作，这些 分析将为量身定做的西班牙语和英语患者辅导干预设计提供信息，以增加 和促进远程医疗使用(AIM 2)和双语干预的试点随机对照试验(AIM 3)。这些目标将使用混合方法、实施科学和数字健康差距来实现 概念框架，因为它们涉及制定干预措施的NIMHD研究优先领域 改善弱势患者获得护理的机会，缩小健康差距。这些研究是新颖的，因为 及时关注针对弱势患者群体的远程医疗实施，解决LEP患者 显性地，以及建议使用混合方法来发展一种理论驱动的干预。建议数 研究由亚历杭德拉·卡西利亚斯博士作为初级保健医生的角色和她的患者门户研究提供信息 在多样化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 缩小数字健康差距，增加健康机会，改善种族/少数民族的健康结果 和LEP患者。在颁奖过程中，卡西利亚斯博士将接受授课和体验式培训。 提高三个领域的知识和技能：(1)数字健康差距研究的混合方法，(2) 安全网中的远程医疗提供，以及(3)在现实世界临床环境中对试点试验干预措施的评估 使用实施科学方法。卡西利亚斯博士组建了一个多机构的指导团队， 互补的专业知识，以确保完成拟议的研究和培训并成功 向独立过渡。这个K23将定位卡西利亚斯博士，作为一名职业生涯早期的调查员，开发一种 NIMHD-R01适用于其他语言和慢性病：研究结果可能导致广泛采用 将这一模式作为一种循证干预，以增强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.