Telemedicine for Patients with Limited English Proficiency: A Mixed Methods Approach to Identifying and Addressing Disparities

项目摘要/摘要 英语水平有限(LEP)的患者被定义为“那些不能有效地在英语中交流的人 占美国患者总数的近9%。13名LEP患者是最常见的群体之一 没有得到美国卫生系统的充分服务。他们获得护理的机会更少，面临更差的质量和安全 结果，并报告对其护理的满意度较低。14-16，18远程医疗的利用率，提供 通过双向同步通信的远程临床服务，已经在一定程度上证明了有效性 并已被提议作为减少健康差距的一般手段。1-4 5然而，研究 在新冠肺炎大流行之前，已经表明LEP患者在获得 基于远程医疗的护理。20-23随着新冠肺炎大流行的继续，远程医疗显然将继续 美国卫生系统的一部分，11，12因此，有必要评估健康的社会决定因素如何 影响弱势群体获得公平的远程医疗服务的能力。我们建议一种混合的 方法顺序说明性设计方法，以确定和解决与以下相关的障碍和促进者 为LEP患者提供远程医疗护理，重点关注其他社会决定因素的交集 关于健康的。我们的方法将使我们能够确定哪些因素可能在数量上导致利用率差异， 然后将为定性评估提供信息，说明为什么存在这些差异，以及如何解决这些差异。 具体目标是1)进行纵向、回溯性分析，比较远程医疗的使用情况和 新冠肺炎大流行前和期间LEP患者的门诊总利用率与英国人的对比 熟练的患者，2)定性地调查如何为LEP患者提供远程医疗访问 通过对与LEP患者工作/互动的医疗保健专业人员进行半结构化采访(例如 服务提供者、社区卫生工作者)和讲西班牙语的LEP患者。为了这两个目标，我们将考虑 健康的社会决定因素的多方面贡献如何与提供高质量、 为LEP患者提供公平的远程医疗服务。结果将被用来提供证据- 为门诊中的LEP患者提供公平远程医疗的最佳实践工具包 将在未来的研究中进行评估。

PROJECT ABSTRACT/SUMMARY Patients with limited English proficiency (LEP) are defined as “those who cannot effectively communicate in English”, make up nearly 9% of the U.S. patient population.13 Patients with LEP are one of the groups most underserved by the U.S. health system. They experience poorer access to care, face worse quality and safety outcomes, and report lower levels of satisfaction with their care.14–16,18 Utilization of telemedicine, the provision of remote clinical services via two-way synchronous communication, has demonstrated efficacy in certain settings and has been proposed as a general means for reducing health disparities. 1–4 5 However, studies prior to the COVID-19 pandemic have indicated patients with LEP also face disparities in accessing telemedicine-based care.20–23 As the COVID-19 pandemic continues, it is clear that telemedicine will remain part of the U.S. health system,11,12 therefore it is essential to assess how social determinants of health may affect vulnerable groups’ ability to receive equitable telemedicine-based services. We propose a mixed methods sequential explanatory design approach to identify and address barriers and facilitators related to providing telemedicine care to patients with LEP, with a focus on the intersection of other social determinants of health. Our approach will allow us to determine what may quantitatively drive disparities in utilization, which will then inform a qualitative assessment why these disparities exist and how they may be resolved.25 The specific aims are to 1) perform a longitudinal, retrospective analysis comparing telemedicine utilization and total outpatient utilization, prior to and during the COVID-19 pandemic by LEP patients to that of English proficient patients, 2) to qualitatively investigate how telemedicine visits are provided to patients with LEP through semi-structured interviews with healthcare professionals working/interacting with LEP patients (e.g. providers, community health workers) and Spanish-speaking patients with LEP. For both aims, we will consider how the multi-faceted contributions of social determinants of health relate to the delivery of high-quality, equitable telemedicine-based services to LEP patients. The results will be utilized to inform an evidence- based toolkit of best practices for equitable telemedicine delivery for patients with LEP in an outpatient setting to be evaluated in future studies.