Protocols to ascertain adverse events after telehealth sexual and reproductive health services

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Project Summary This mentored Ruth L. Kirschstein National Research Service Award will provide the trainee, a PhD student in epidemiology at UCSF, with the training necessary to become a researcher in sexual and reproductive health. Her training goals for this fellowship are to gain expertise in health services research, bias analyses, and methods to address missing data under the guidance of a team of expert mentors. This fellowship will provide the applicant with the skills, content knowledge, and practical experience to launch an independent research career focused on the evaluation of service delivery innovations in sexual and reproductive health. Telehealth became a prominent method of sexual and reproductive health service delivery during the COVID- 19 pandemic. In telehealth services, patients are typically screened remotely, dispensed any medications by mail, and followed subsequently to monitor for the occurrence of adverse events. Some research suggests that telehealth patients may be less likely than those who receive in-person services to follow up with the telehealth provider after medications are dispensed, and the outcomes of patients who do not complete follow-up are not understood. The goal of this research is to evaluate the performance of telehealth protocols at identifying adverse events. Building on the applicant’s prior work and current research position, this F-31 will involve secondary analyses of data from a cohort study of patients who received telehealth sexual and reproductive health services, to (Aim 1) estimate the incidence of adverse events among patients who do not return for follow-up and (Aim 2) assess the timing and process of adverse events diagnoses after telehealth sexual and reproductive health services. This evidence will allow telehealth sexual and reproductive health providers to understand the risk of adverse events among their patients who do not return for follow-up and whether their current follow-up protocols are optimal for the identification of adverse events. Knowledge gained from this research will advance NICHD’s mission to ensure individuals are born healthy and wanted and that women are not harmed by reproductive processes. The major strengths of this proposal are that it: (1) relies on a large existing prospective dataset of US telehealth sexual and reproductive health patients, with which the applicant already has experience; (2) uses rigorous methods for evaluating bias and addressing missing data; and (3) tests clinically impactful hypotheses focusing on the timely and growing field of telehealth for sexual and reproductive health. The proposed research and training will prepare the applicant for her future career as an independent researcher focused on service delivery innovations in sexual and reproductive health care.