Patient income level and health insurance correlate with differences in health care utilization during the COVID-19 pandemic.

Background: With the coronavirus outbreak of 2019 (COVID-19) came many changes in how health care is accessed and delivered. Perhaps most notable is the massive expansion of telemedicine, especially in the developed world. With pandemic-induced economic and health care system disruptions, it is reasonable to expect changes in how health care services are utilized by different patients. We examined how health care service usage trends changed for various patient demographics from the pre-COVID-19 era to the COVID-19 era. Design and methods: De-identified patient demographics and telemedicine, in-patient, in-person out-patient, radiology/procedures, and emergency department visit data (N = 1,164,719) between January 1st, 2019 and May 31st, 2021 were obtained from UHealth in Miami, Florida, USA. This cross-sectional study employed descriptive statistics and other tools to determine relationships between patient demographics and health system usage. Results: There were significant changes in health care usage and demographics for UHealth services from the pre-COVID-19 era to the COVID-19 era. There was an increase in telehealth visits and a corollary decrease of in-person out-patient visits (p < 0.001) along with increased health care utilization by those with commercial insurance (p < 0.001) during COVID-19. Lower-income patients had increased use of in-person out-patient services (p < 0.001). Non-Hispanic, English-speaking patients and those with higher median incomes had higher telemedicine usage. Conclusions: COVID-19 revealed differences in health care access, particularly telemedicine access, and highlighted differences in vulnerability among patient demographics. These trends are likely multifactorial and reflect changes in patients' preferences and disparities in care access.

Development of an Effective Electronic Medical Record for Student-Run Free Health Fairs Using Research Electronic Data Capture (REDCap) Software.

BACKGROUND: The University of Miami Mitchell Wolfson Sr. Department of Community Service (DOCS) is a student-run organization providing free health care to the medically underserved in South Florida. For a large organization providing care to thousands of people per year, an effective electronic medical record (EMR) is necessary to keep track of patient records. METHODS: A REDCap project was configured in a way that allows it to mimic a basic EMR. This was done by assigning patients medical record numbers, creating repeating events allowing patient results to be seen over time, and incorporating extensive logic to facilitate clinical decision-making. RESULTS: DOCS was able to create a basic EMR using REDCap and has seen success with this approach. DISCUSSION: REDCap is capable of functioning as a robust, basic EMR which can be suitable for any purpose. It is HIPAA-compliant, comprehensive and low-cost, making it suitable for serving underserved populations.

Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study.

BACKGROUND: With COVID-19 there was a rapid and abrupt rise in telemedicine implementation often without sufficient time for providers or patients to adapt. As telemedicine visits are likely to continue to play an important role in health care, it is crucial to strive for a better understanding of how to ensure completed telemedicine visits in our health system. Awareness of these barriers to effective telemedicine visits is necessary for a proactive approach to addressing issues. OBJECTIVE: The objective of this study was to identify variables that may affect telemedicine visit completion in order to determine actions that can be enacted across the entire health system to benefit all patients. METHODS: Data were collected from scheduled telemedicine visits (n=362,764) at the University of Miami Health System (UHealth) between March 1, 2020 and October 31, 2020. Descriptive statistics, mixed effects logistic regression, and random forest modeling were used to identify the most important patient-agnostic predictors of telemedicine completion. RESULTS: Using descriptive statistics, struggling telemedicine specialties, providers, and clinic locations were identified. Through mixed effects logistic regression (adjusting for clustering at the clinic site level), the most important predictors of completion included previsit phone call/SMS text message reminder status (confirmed vs not answered) (odds ratio [OR] 6.599, 95% CI 6.483-6.717), MyUHealthChart patient portal status (not activated vs activated) (OR 0.315, 95% CI 0.305-0.325), provider's specialty (primary care vs medical specialty) (OR 1.514, 95% CI 1.472-1.558), new to the UHealth system (yes vs no) (OR 1.285, 95% CI 1.201-1.374), and new to provider (yes vs no) (OR 0.875, 95% CI 0.859-0.891). Random forest modeling results mirrored those from logistic regression. CONCLUSIONS: The highest association with a completed telemedicine visit was the previsit appointment confirmation by the patient via phone call/SMS text message. An active patient portal account was the second strongest variable associated with completion, which underscored the importance of patients having set up their portal account before the telemedicine visit. Provider's specialty was the third strongest patient-agnostic characteristic associated with telemedicine completion rate. Telemedicine will likely continue to have an integral role in health care, and these results should be used as an important guide to improvement efforts. As a first step toward increasing completion rates, health care systems should focus on improvement of patient portal usage and use of previsit reminders. Optimization and intervention are necessary for those that are struggling with implementing telemedicine. We advise setting up a standardized workflow for staff.

Demographics associated with US healthcare disparities are exacerbated by the telemedicine surge during the COVID-19 pandemic.

INTRODUCTION: As coronavirus disease 2019 (COVID-19) hit the US, there was widespread and urgent implementation of telemedicine programs nationwide without much focus on the impact on patient populations with known existing healthcare disparities. To better understand which populations cannot access telemedicine during the coronavirus disease 2019 pandemic, this study aims to demographically describe and identify the most important demographic predictors of telemedicine visit completion in an urban health system. METHODS: Patient de-identified demographics and telemedicine visit data (N = 362,764) between March 1, 2020 and October 31, 2020 were combined with Internal Revenue Service 2018 individual income tax data by postal code. Descriptive statistics and mixed effects logistic regression were used to determine impactful patient predictors of telemedicine completion, while adjusting for clustering at the clinical site level. RESULTS: Many patient-specific demographics were found to be significant. Descriptive statistics showed older patients had lower rates of completion (p < 0.001). Also, Hispanic patients had statistically significant lower rates (p < 0.001). Overall, minorities (racial, ethnic, and language) had decreased odds ratios of successful telemedicine completion compared to the reference. DISCUSSION: While telemedicine use continues to be critical during the coronavirus disease 2019 pandemic, entire populations struggle with access-possibly widening existing disparities. These results contribute large datasets with significant findings to the limited research on telemedicine access and can help guide us in improving telemedicine disparities across our health systems and on a wider scale.

Acceptability and Feasibility of Home-Based Hepatitis B Screening Among Haitian Immigrants.

Hepatitis B (HBV) is endemic in Haiti, therefore Haitian immigrants should be screened to identify and link affected individuals to care. Current screening approaches are ineffective. We assessed the acceptability and feasibility of home-based screening among Haitian immigrants using community health workers (CHWs). We recruited participants exiting a pragmatic trial evaluating strategies to improve care delivery (NCT02970136). Participants completed an acceptability questionnaire. Blood drawn by CHWs at participants' homes or community sites was tested for hepatitis B surface antigen, hepatitis B surface antibody and hepatitis B core antibody. Of 60 participants, 59 found screening acceptable; 53 had blood drawn. Of those, 45.3% had HBV previously, 49.1% remained susceptible and 5.7% were vaccinated. Respondents cited various reasons community members might find screening unacceptable. The high prior HBV rate highlights the need for effective outreach programs. Home-based HBV screening was both acceptable and feasible among Haitian immigrants.