TELE Para DM: Telemedicine Equity for Limited English Proficient Patients with Diabetes Mellitus in the Safety Net

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Project Summary/Abstract Telemedicine (remote telephone and video health visits) is a digital health tool that can increase access to care and improve health outcomes. Telemedicine care has been critical to maintaining healthcare access when in- person care is disrupted, and the arrival of the Coronavirus-19 disease (COVID-19) pandemic forced the integration of telemedicine into care almost overnight. But this is problematic for safety net health systems who disproportionately provide care to racial/ethnic minority and Limited English Proficient (LEP) patients, who have faced significant barriers with past digital health technology. In this K23, we will study telemedicine in the Los Angeles County Department of Health Services (LAC DHS)— the second largest safety net in the United States. We will focus on a particularly vulnerable population with need for frequent, interval care: patients with diabetes mellitus (DM), specifically addressing LEP Spanish-speakers, who are 62% of the DM patients at LAC DHS. This K23 proposal will investigate differences in factors affecting telemedicine use and explore associated quality of diabetic care via quantitative and qualitative analyses among Spanish- and English- speaking primary care patients (Aim 1). In partnership with the LAC DHS Virtual Care Workgroup, these analyses will inform the tailored design of a patient coaching intervention in Spanish and in English to increase and facilitate telemedicine use (Aim 2) and a pilot randomized controlled trial of the bilingual intervention (Aim 3). These aims will be achieved using mixed methods, implementation science, and digital health disparities conceptual frameworks as they address the NIMHD research priority areas of developing interventions to improve access to care for vulnerable patients and reduce health disparities. The studies are novel given the timely focus on telemedicine implementation for vulnerable patient populations, addressing LEP patients explicitly, as well as the proposed use of mixed methods to develop a theory-driven intervention. The proposed studies are informed by Dr. Alejandra Casillas’ role as a primary care physician and her patient portal research experience in diverse, urban primary care settings. Dr. Casillas’ long-term goal is to develop interventions that reduce digital health disparities, increase health access, and improve health outcomes for racial/ethnic minority and LEP patients. During the course of this award, Dr. Casillas will undertake didactic and experiential training to improve knowledge and skills in three areas: (1) mixed methods in digital health disparities research, (2) telemedicine delivery in the safety net, and (3) evaluation of pilot trial interventions in real-world clinical settings using implementation science methods. Dr. Casillas has assembled a multi-institutional mentorship team with the complementary expertise to ensure completion of the proposed research and training and successful transition to independence. This K23 will position Dr. Casillas, as an early career investigator, to develop a NIMHD-R01 for other languages and chronic disease conditions: findings could result in widespread adoption of this model as an evidence-based intervention to augment telemedicine for vulnerable patients in the US.