Center of Excellence in Precision Medicine and Population Health

COVID-19大流行对每个人的影响并不相同。在田纳西州的纳什维尔， COVID-19病例在邮政编码地区更高，这些地区的健康社会决定因素更差， 哮喘等疾病的发病率更高。为了提供安全、有效和远距离的护理， 远程医疗已成为首选的保健服务提供方式。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。 弱势群体往往无法获得这些服务，此外，他们可能有隐私问题， 对远程医疗不太信任现在，卫生与人类服务部（HHS）的远程医疗指南 放松，为低收入的不同人群从家中访问这种模式创造了更大的便利， 必须建立一种机制，以确保公平获得服务，从而能够采取更精确、更有针对性的办法。尽管有迹象表明 儿童感染COVID-19的频率低于成人，儿童卫生保健的整体利用率 自大流行病在物理距离要求方面取得进展以来， 远程医疗在儿童中的应用并没有增加。如果这些儿童来自代表性不足的少数群体，情况尤其如此。我们提出了一个行政补充，以了解是什么使 远程医疗在得不到充分服务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患者 具有较高社会需求的家庭（N=500），并测量早期 2019冠状病毒病大流行期间（2020年3月1日至6月30日）。我们将进行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，COVID-19影响，技术获取， 种族/民族和患者信任。然后，我们将使用所获得的知识进行前瞻性设计和测试 经修改的远程医疗方法，评估为下列人员提供远程医疗服务的可行性和可接受性： 100名低收入儿科患者（50名英语和50名非英语）。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，患者家庭和提供者满意度。 收集的定性数据将确定患者家庭和供应商的障碍和促进因素。这些数据将 为政策和程序提供信息，为不同的儿科人群制定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.