ABSTRACT
Most analysts and healthcare systems agree that telehealth volumes will continue to be markedly higher than levels prior to the COVID-19 pandemic.1 The rapid increase required clinicians, including trainees across various specialties, to practice medicine via telehealth for the first time. Research shows that very few residency programs offer formal training and education around telehealth.2,3 Although recent research has detailed telehealth training at the undergraduate medical education level, little of this research is available at the Graduate Medical Education (GME) level. [...]the Association of American Medical Colleges (AAMC) has set standards for telehealth education, outlining guidelines to create curricula.4 This contrasts with the finding that very few Accreditation Council for Graduate Medical Education (ACGME) milestones mention telehealth or competencies related to the delivery of care via this modality.5 We set out to quantify this education gap in order to better understand its impact on trainees providing care via telehealth. If the core competencies highlighted in the table are not incorporated into GME curricula, we run the risk of telehealth becoming a substandard modality of care delivery that cannot maintain the same quality of care due to a lack of appropriate training of the providers responsible for its delivery. With the incorporation of program-specific telehealth competencies, this modality of care delivery has the ability to expand access, improve outcomes of chronic disease management, and strengthen the patient–provider relationship across all specialties.
ABSTRACT
OBJECTIVE: During the coronavirus disease 2019 pandemic, as a safety-net organization with a substantial percentage of patients of color and with limited English proficiency (LEP), we were wary of furthering health disparities in our community. We analyzed gaps in telemedicine (telephone and video) delivery in our communities, quantified the effects of our tests of change, and began the process of accumulating evidence to create a road map for other organizations. METHODS: We leveraged Lean problem-solving strategies to identify modifiable gaps across multiple domains that could inhibit equity in telemedicine. We implemented tests of change across domains of community engagement, technology, education, and access. We observed the proportion of telemedicine encounters across races and languages between April and November, 2020. Regression analyses tested the impact of race and language on telemedicine controlling for age, gender, insurance, and time. RESULTS: Several rounds of changes and enhancements were associated with changes in telemedicine use of +5.5% (p < 0.0001) for Hispanic, +4.0% (p < 0.0001) for Spanish-speaking, -2.1% for Black (p < 0.05), and -4.4% for White patients (p < 0.001). African-American, Hispanic, and non-English-speaking patients had between 2.3 and 4.6 times the odds of preferring telephone to video encounters (p < 0.0001), with increases in preferences for video use over time (p < 0.05). CONCLUSION: Our roadmap to improve equitable delivery of telemedicine was associated with a significant improvement in telemedicine use among certain minority populations. Most populations of color used telephone more often than video. This preference changed over time and with equity-focused changes in telemedicine delivery.