Administrative Core

新冠肺炎疫情对所有人的影响并不是一样的。在田纳西州的纳什维尔，确认的人数 新冠肺炎病例在受较差的健康和社会决定因素影响的邮政编码地区较高 哮喘等疾病的发生率更高。为了实现安全、有效和距离遥远的护理， 远程医疗已经成为优先提供医疗保健的一种方式。然而，远程医疗需要 获得技术，宽带互联网接入，技术素养，在许多情况下，英语熟练程度。 这些网站通常是弱势群体无法访问的，此外，他们可能有隐私问题，并且 减少对远程医疗的信任。现在，卫生与公众服务部(HHS)的远程医疗指南是 宽松，为低收入多样化人口在家中使用这种方式创造了更大的便利，它 必须确保接入公平，以便采取更精确的量身定制方法。尽管有迹象表明 儿童感染新冠肺炎的几率低于成年人，总体儿童卫生保健的利用率 自大流行获得物理距离要求以来大幅下降，但使用 儿童远程医疗的比例并没有增加。如果这些儿童来自代表性不足的少数族裔人口，情况尤其如此。我们提出了一个行政补充，以了解是什么导致 远程医疗在服务不足的人群中是可行和可接受的。在目标1中，我们将随机选择范德比尔特 居住在邮政编码地区的儿科初级保健患者反映了种族和民族多样性的患者 有较高社会需求的家庭(N=500)，并衡量早期远程医疗的回溯性利用情况 新冠肺炎大流行期间(2020年3月1日至6月30日)。我们将进行一场30-60分钟的电话 以参与者选择的语言(英语、西班牙语或阿拉伯语)进行调查，以评估远程医疗的利用情况， 知识、兴趣、健康的社会决定因素、对新冠肺炎的影响、技术获取 种族/民族，以及病人的信任。然后，我们将使用所获得的知识进行前瞻性的设计和测试 改进的远程医疗方法，评估向以下人员提供远程医疗访问的可行性和可接受性 100例低收入儿科患者(50例英语和50例非英语)。收集的过程数据将包括选定的 远程医疗平台(HHS接受的选择)、就诊时间以及患者与家人和提供者之间的满意度。 收集的定性数据将确定患者家属和提供者之间的障碍和促进者。这些数据将 为政策和进程提供信息，以便为不同的儿科人口创造公平的远程保健方法。

The COVID-19 pandemic is not affecting everyone equally. In Nashville, Tennessee, the number of confirmed COVID-19 cases are higher in ZIP Code regions that are burdened by poorer social determinants of health and higher rates of conditions such as asthma. To allow for safe, effective, and physically distant care, telemedicine has emerged as a modality for preferred health care delivery. However, telemedicine requires access to technology, broadband internet access, technologic literacy, and in many cases, English proficiency. These are often inaccessible to vulnerable populations who, additionally, may have privacy concerns and be less trusting of telemedicine. Now that the Health and Human Services (HHS) guidelines for telemedicine are relaxed, creating greater ease for lower income diverse populations to access this modality from their home, it must be built to ensure access equity that allows for a more precise tailored approach. Despite indications that children are less often infected with COVID-19 than adults, utilization of overall child health care has decreased substantially since the pandemic gained traction with physical distancing requirements, but the use of telemedicine in children has not increased. This is especially true if those children are from underrepresented minority populations. We propose an administrative supplement to understand what makes telemedicine feasible and acceptable in underserved populations. In Aim 1, we will randomly select Vanderbilt Pediatric Primary Care patients who live in ZIP Code regions reflective of racially and ethnic diverse patient families with higher social needs (N=500) and measure retrospective telemedicine utilization during the early period of the COVID-19 pandemic (from March 1- June 30, 2020). We will conduct a 30-60 minute telephonic survey in the participant language of choice (English, Spanish, or Arabic) to assess telemedicine utilization, knowledge, interest, accounting for social determinants of health, COVID-19 impact, technology access, race/ethnicity, and patient trust. We will then use the knowledge gained to prospectively design and test modified telemedicine approaches, assessing the feasibility and acceptability of telemedicine visits provided to 100 low-income pediatric patients (50 English and 50 non-English). Process data collected will include selected telemedicine platform (of the HHS accepted choices), visit length, and patient-family and provider satisfaction. Qualitative data collected will identify both patient-family and provider barriers and facilitators. These data will inform policies and processes to create equitable telehealth approaches for diverse pediatric populations.