Telemedicine for Patients with Limited English Proficiency: A Mixed Methods Approach to Identifying and Addressing Disparities

针对英语水平有限的患者的远程医疗：识别和解决差异的混合方法

• 批准号: 10508102
• 负责人: Natalie Christine Benda
• 金额: $ 3.08万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10508102
• 关键词: Telemedicine; Patients; Limited; English; Proficiency

PROJECT ABSTRACT/SUMMARY Patients with limited English proficiency (LEP) are defined as “those who cannot effectively communicate in English”, make up nearly 9% of the U.S. patient population.13 Patients with LEP are one of the groups most underserved by the U.S. health system. They experience poorer access to care, face worse quality and safety outcomes, and report lower levels of satisfaction with their care.14–16,18 Utilization of telemedicine, the provision of remote clinical services via two-way synchronous communication, has demonstrated efficacy in certain settings and has been proposed as a general means for reducing health disparities. 1–4 5 However, studies prior to the COVID-19 pandemic have indicated patients with LEP also face disparities in accessing telemedicine-based care.20–23 As the COVID-19 pandemic continues, it is clear that telemedicine will remain part of the U.S. health system,11,12 therefore it is essential to assess how social determinants of health may affect vulnerable groups’ ability to receive equitable telemedicine-based services. We propose a mixed methods sequential explanatory design approach to identify and address barriers and facilitators related to providing telemedicine care to patients with LEP, with a focus on the intersection of other social determinants of health. Our approach will allow us to determine what may quantitatively drive disparities in utilization, which will then inform a qualitative assessment why these disparities exist and how they may be resolved.25 The specific aims are to 1) perform a longitudinal, retrospective analysis comparing telemedicine utilization and total outpatient utilization, prior to and during the COVID-19 pandemic by LEP patients to that of English proficient patients, 2) to qualitatively investigate how telemedicine visits are provided to patients with LEP through semi-structured interviews with healthcare professionals working/interacting with LEP patients (e.g. providers, community health workers) and Spanish-speaking patients with LEP. For both aims, we will consider how the multi-faceted contributions of social determinants of health relate to the delivery of high-quality, equitable telemedicine-based services to LEP patients. The results will be utilized to inform an evidence- based toolkit of best practices for equitable telemedicine delivery for patients with LEP in an outpatient setting to be evaluated in future studies.

项目摘要/总结 英语水平有限的患者（LEP）被定义为“那些无法有效沟通的人”。 英语”，占美国患者人口的近9%。13 LEP患者是最常见的人群之一。 美国卫生系统服务不足。他们获得护理的机会较少，面临更差的质量和安全 14 - 16，18利用远程医疗，提供远程医疗， 通过双向同步通信的远程临床服务，在某些方面已经证明了有效性。 这是一项针对特定环境的政策，并被提议作为减少健康差距的一般手段。1-4 5、研究 在COVID-19大流行之前，LEP患者也面临着获得 20 -23随着COVID-19大流行的持续，很明显，远程医疗将继续 作为美国卫生系统的一部分，11，12因此，评估健康的社会决定因素如何可能 影响弱势群体获得公平的远程医疗服务的能力。我们提出一个混合的 方法顺序解释性设计方法，以确定和解决有关的障碍和促进因素 为LEP患者提供远程医疗护理，重点关注其他社会决定因素的交叉点 of health.我们的方法将使我们能够确定什么可能定量地导致利用率的差异， 然后，将提供一个定性评估，说明为什么存在这些差异，以及如何解决这些差异。 具体目标是：1）进行纵向回顾性分析，比较远程医疗的利用率， 2019冠状病毒病大流行之前和期间，LEP患者的门诊总利用率与英语患者的门诊总利用率 熟练的患者，2）定性研究如何为LEP患者提供远程医疗访问 通过与与LEP患者工作/互动的医疗保健专业人员的半结构化访谈（例如， 提供者，社区卫生工作者）和讲西班牙语的LEP患者。为了这两个目标，我们会考虑 健康的社会决定因素的多方面贡献如何与提供高质量的， 为LEP患者提供公平的远程医疗服务。结果将用于提供证据- 为门诊LEP患者提供公平远程医疗服务的最佳实践工具包 在未来的研究中进行评估。