Toward Technology Equity: Extending Telemedicine to Latino Patients with Type II Diabetes

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PROJECT ABSTRACT Latinos are disproportionately affected by type II diabetes. They have an age-adjusted incidence rate of 9.7 per 1000 persons, nearly double the rate for non-Latino Whites. Once diagnosed with diabetes, Latinos experience worse glycemic control and diabetes-related complications compared to non-Latino patients. These inequities are driven by multiple interrelated biological, cultural, and social factors. In particular, a lack of access to consistent care and difficulty navigating the healthcare system are critical drivers of these disparities. By extending care beyond the clinic, telemedicine presents an opportunity to address these challenges. Telemedicine offers patients video and telephone visits from remote settings. However, current implementation strategies have created significant gaps in telemedicine access and use among Latinos, especially those who are limited English proficient (LEP). The goal of this K23 is to address this critical need by evaluating how a culturally and linguistically tailored implementation strategy can increase telemedicine use by Latino patients with diabetes. My central hypothesis is that by applying a human-centered design approach supported by implementation science, we can improve telemedicine use, an important part of addressing diabetes disparities. The proposed project will test the central hypothesis with the following 3 specific aims. Aim 1 will evaluate existing electronic health record data, telemedicine platforms, and workflows to identify multilevel contributors to telemedicine use gaps among Latino patients with diabetes. Aim 2 will engage stakeholders to develop a multilevel, tailored intervention targeted at patients and clinicians to promote telemedicine use in the care of Latino patients with diabetes. Aim 3 will conduct a pilot randomized controlled trial of the multilevel, tailored intervention among Latino patients with diabetes and their clinicians. Through an innovative application of human-centered design and implementation science, this proposal addresses overlapping health information technology and diabetes disparities among Latino patients, especially those who are LEP. The proposed research is complemented by a rigorous training plan and a highly experienced mentorship team that will ensure my transition to independence. The training plan focuses on mixed-effect logistic regression, implementation science, human-centered design, and trial design. This proposal will form the basis for an R01 application centering on a larger clinical trial testing the effect of the implementation intervention on clinical outcomes among Latino patients with diabetes.