Age, Race, and Digital Divide Index are Associated With Video Visit Completion for Patients Seen in Radiation Oncology

Abstract

The COVID-19 pandemic drove rapid adoption of telehealth across medicine, including radiation oncology, to minimize inperson contact. This exposed patient barriers to telehealth access and created care disparities in the absence of specific access assistance which have been little studied. A better understanding of these telehealth access barriers will help direct assistance resources to improve access in radiation oncology patients in the future. Materials/Methods: Data for all unique patient visits at a large academic medical center between 4/1/2020 and 6/30/2020 were generated, including visit type (in person, video, audio only), age, race, ethnicity, rural/urban home address (zip code assessment by Federal Office of Rural Health Policy), and Digital Divide Index (DDI; incorporates metrics of technology and internet access, age, disability, and educational attainment in a geographic area). A multivariable logistic regression model evaluated the association of these variables with successful video visit completion. Results: A total of 1990 visits by patients seen in radiation oncology for 1698 unique individuals were assessed. The median age was 66 (IQR: 14); patients were 38.1% female and 89.4% Caucasian. The median age of those completing at least one video visit was 64 (IQR: 15) vs. 68 (IQR: 14) for those who completed audio visits only (P < 0.001). Among African American patients, 22.7% completed at least one video visit, while 36.7% of Caucasian patients completed at least one video visit (P = 0.003). In multivariable analyses, patient age (OR: 0.965; 95% CI 0.956-0.973; P < 0.001), DDI (OR: 0.986; 95% CI 0.976-0.996; P = 0.006), and race (OR: 0.472; 0.294-0.756; P = 0.039) predicted completion of at least one video visit. Those who were older, had higher DDI (greater digital divide), or African American race were less likely to complete a video visit. Gender, ethnicity, and rural/urban home address were not significantly associated with video visit completion. Conclusion: This work is to our knowledge the first characterization of telehealth usage in radiation oncology patients and demonstrates associations between patient characteristics and video visit completion that have implications for clinical practice and future research. First, older patients, those with minority backgrounds, and those from areas with less access to technology (high digital divide) are less likely to be able to access care through video visits. Second, audio visits were a significant proportion of visits early in the pandemic, and subsequent data should be analyzed to determine their importance as a means to continue providing virtual care to prevent further care disparities. Third, future research is needed to address barriers to care experienced by elderly and minority patients as well as those from communities with high DDI. Fourth, researchers should explore markers of access barriers such as DDI and other potential pre-visit screening metrics for use in directing resources to those in need.

The impact of telehealth on nursing care in the radiation oncology setting during the COVID-19 pandemic

“… 9 , 10 , 11 , 15 In taking a more proactive approach to future infrastructure and development, Wosik et al 9 urged healthcare systems to create a more sustainable telehealth infrastructure that efficiently maximizes hospital staff and resources. In a systematic review of video visits completed for patients seen in radiation oncology during the peak of the pandemic, Cousins et al 17 found that certain patient characteristics (e.g., older age, minority background, geographical location) are less likely to be able to access care through video visits. Thus, the development of ways to identify underserved groups and methods to bridge the digital divide are warranted for successful telehealth outcomes.…”