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Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review.
Bailey, James E; Gurgol, Cathy; Pan, Eric; Njie, Shirilyn; Emmett, Susan; Gatwood, Justin; Gauthier, Lynne; Rosas, Lisa G; Kearney, Shannon M; Robler, Samantha Kleindienst; Lawrence, Raymona H; Margolis, Karen L; Osunkwo, Ifeyinwa; Wilfley, Denise; Shah, Vallabh O.
  • Bailey JE; Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States.
  • Gurgol C; Patient-Centered Outcomes Research Institute, Washington, DC, United States.
  • Pan E; Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States.
  • Njie S; Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States.
  • Emmett S; Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States.
  • Gatwood J; College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States.
  • Gauthier L; Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States.
  • Rosas LG; Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States.
  • Kearney SM; Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States.
  • Robler SK; Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States.
  • Lawrence RH; Norton Sound Health Corporation, Nome, AK, United States.
  • Margolis KL; Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States.
  • Osunkwo I; HealthPartners Institute, Minneapolis, MN, United States.
  • Wilfley D; Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States.
  • Shah VO; Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States.
J Med Internet Res ; 23(12): e28503, 2021 12 07.
Article in English | MEDLINE | ID: covidwho-1591475
ABSTRACT

BACKGROUND:

Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities.

OBJECTIVE:

This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities.

METHODS:

A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study.

RESULTS:

PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information.

CONCLUSIONS:

Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / Ethnic and Racial Minorities Type of study: Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 28503

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / Ethnic and Racial Minorities Type of study: Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 28503