Telehealth and Reproductive Health Equity

项目摘要 历史上被边缘化的人群，如有色人种，低收入人群和移民 人口在生殖保健方面面临的障碍不成比例。远程保健选项， 生殖保健服务正在增长，可能会解决距离和费用方面的一些障碍 访问。对初级保健远程保健的研究表明，它可以弥合地理差异， 允许更容易的语言翻译，感觉更安全，更私人的移民人口，更少 价格昂贵，而且需要较少的工作或上学时间。相反，远程医疗服务可能会加剧 如果患者缺乏技术、数字素养和可靠的互联网覆盖，就会造成不公平。我们的长期目标 是减少医疗服务的差异，并优化历史上群体的远程医疗 被边缘化的人，包括有色人种，低收入者和移民。的目标 这项研究是为了确定远程医疗是否为患者提供更及时和负担得起的 生殖保健，远程保健是否覆盖了卫生不平等程度较高地区的人们，以及 远程医疗患者更喜欢哪些属性。 远程健康和生殖健康公平研究将招募2,000名患者， 生殖保健。一个队列将包括1，000名寻求远程医疗或面对面医疗的患者 通过诊所提供服务。第二组1,000名寻找生殖器官的患者 在线医疗保健提供者将使用Google Ads进行招聘。在目标1中，我们将确定 哪些远程保健服务影响时间、成本和相对于亲自护理的后续护理。我们还将 比较远程保健和面对面群体之间的计划外面对面护理的比率。队列 从诊所和通过谷歌广告招募将分别进行分析。在目标2中，我们将进行 对患者人口普查区块组或区域进行地理空间分析，以确定是否与患者相比 使用人工流产护理的人，使用远程保健的病人居住在更健康的地区 不平等我们将使用四个社会脆弱性指数比较远程保健和面对面的群体。 在目标3中，我们将确定远程保健用于生殖保健的偏好和障碍， 关注历史上被边缘化的人群。我们将使用两种传统上使用的创新方法 对于市场研究，采用离散选择实验和最大差异分析法。 这项研究解决了在获得医疗保健方面存在的巨大和日益扩大的差距， 历史上被边缘化的群体。拟议研究的结果将提供明确的指导， 医疗保健提供者如何设计远程医疗服务，以便他们可以访问和吸引 有色人种、低收入人群和移民。我们的研究结果将有助于数字包容， 增加了医疗服务的可及性，并将适用于医疗保健的所有领域。

PROJECT SUMMARY Historically marginalized populations such as people of color, low-income people, and immigrant populations disproportionately face barriers to reproductive healthcare. Telehealth options for reproductive health care services are growing and may address some of the distance and cost barriers to access. Research on telehealth for primary care suggests that it may bridge geographic disparities, allow for easier language translations, feel safer and more private for immigrant populations, be less expensive, and require less time off work or school. Conversely, telehealth services could exacerbate inequities if patients lack technology, digital literacy, and reliable internet coverage. Our long-term goal is to reduce disparities in healthcare access and to optimize telehealth for groups historically marginalized from healthcare including people of color, low-income people, and immigrants. The goal of this research is to determine whether telehealth provides patients with more timely and affordable reproductive healthcare, whether telehealth reaches people in areas with greater health inequities, and which attributes of telehealth patients prefer. The Telehealth and Reproductive Health Equity study will enroll 2,000 patients seeking reproductive health care. One cohort will comprise 1,000 patients seeking telehealth or in-person services through the clinic sites. A second cohort of 1,000 patients searching for a reproductive healthcare provider online will be recruited using Google Ads. In Aim 1 we will determine the ways in which telehealth services affect timing, costs, and follow-up care relative to in-person care. We will also compare rates of unplanned in-person care between telehealth and in-person groups. The cohorts recruited from clinics and via Google Ads will be analyzed separately. In Aim 2 we will conduct a geospatial analysis of patient census block groups or tracts to determine whether compared to patients using in-person care for abortion care, patients using telehealth reside in areas with greater health inequities. We will compare the telehealth and in-person groups using four social vulnerability indices. In Aim 3 we will determine preferences in and barriers to telehealth for reproductive healthcare, focusing on historically marginalized populations. We will use two innovative methods traditionally used for market research, the discrete choice experiment and maximum difference analysis. This research addresses substantial and increasing disparities in access to healthcare in historically marginalized groups. The results of the proposed research will provide clear guidance on how health care providers can design telehealth services so that they are accessible and attractive to people of color, low-income people, and immigrants. Our results will contribute to digital inclusion and increased health access and will be applicable to all areas of healthcare.