Understanding the Impact of Technology Access and Digital Literacy on Post-Discharge Care and Hospital Readmissions in Adults with Cardiovascular Disease

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PROJECT SUMMARY This R03 award will extend the scope of a parent K23 award to help establish Dr. Oanh Nguyen as a clinician-investigator focused on designing, implementing, and evaluating novel transitional care interventions that address social vulnerabilities in tandem with medical needs to improve health outcomes for vulnerable patients with cardiovascular illness. This award will enable her to extend the scope of her parent K23 work on understanding how social vulnerabilities affect post-discharge care to also encompass understanding the role of limited technology access and digital literacy as social vulnerabilities that may exacerbate already-existing disparities in congestive heart failure (CHF) and ischemic heart disease (IHD) readmissions and post- discharge care. As post-hospitalization care delivery has shifted to telehealth due to the unprecedented COVID-19 pandemic, an increasingly important but underrecognized social need is limited access and use of telehealth among underserved populations. The recent rapid, seismic shift to telehealth has taken place without attention to barriers and facilitators to telehealth among patients in safety-net health systems across the U.S. Individuals from low-income and minority backgrounds are already less likely to follow up with needed outpatient care at discharge, and these disparities are likely worsen with the in outpatient care delivery to telehealth, since low-income individuals are also less likely to use telehealth than other patient subgroups and thus will be even less likely to receive critical post-discharge outpatient follow-up. Although technology access and digital literacy are foundational to using telehealth, the prevalence of technology access and digital literacy among hospitalized patients; how limited technology access and digital literacy affects post-discharge care/recovery; and patient-perceived barriers and enablers to telehealth use among underserved adults hospitalized for CHF and IHD is unknown. Informed by her clinical experience and preliminary studies, and using the COM-B model for behavioral change as a conceptual framework, Dr. Nguyen will conduct a series of studies to: 1) develop and conduct a prospective survey study to understand the prevalence of technology access and digital literacy, and attitudes to telehealth among hospitalized adults with CHF and IHD (Aim 1), and 2) understand patient perceptions on how technology access and digital literacy affect post-discharge care and recovery, and patient-perceived barriers and enablers to telehealth (Aim 2). These findings along with those from her parent K23 will form the basis for an R01 application for a fully powered randomized controlled trial to assess the impact of a hospital- based, personalized, and patient-centered intervention to improve care transitions and prevent readmissions by improving equity in post-discharge care and access and use of telehealth among other social vulnerabilities in underserved adults hospitalized with CHF and IHD.