Association of Race and Neighborhood Disadvantage with Patient Engagement in a Home-Based COVID-19 Remote Monitoring Program

Fritz, Bradley A.; Ramsey, Brett; Taylor, Dick; Shoup, John Paul; Schmidt, Jennifer M.; Guinn, Megan; Maddox, Thomas M.

doi:10.1007/s11606-021-07207-4

Cited by 11 publications

(9 citation statements)

References 30 publications

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“…8 Fritz et al further suggest that race and neighborhood disadvantage impact patients' choice of RPM program type (telephone-based vs patient portal app). 9 Notwithstanding the numerous barriers to equitable access to virtual care options, telehealth is here to stay. Therefore, health systems should find effective ways to mitigate the digital divide.…”

Section: Introductionmentioning

confidence: 99%

Stop the Divide: Facilitators and Barriers to Uptake of Digital Health Interventions Among Socially Disadvantaged Populations

Price‐Haywood

Arnold

Harden-Barrios

et al. 2023

TOJ

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Background:The coronavirus disease 2019 pandemic ushered in rapid adoption of telehealth services. This study examines patient and provider experience and provides recommendations for facilitating the use of digital health interventions among socially disadvantaged populations. Methods: This qualitative study was conducted from May to July 2021 via semistructured interviews. Forty patients and 30 primary care providers (PCPs) in Louisiana were recruited within an integrated delivery health system and a rural health center. Technology acceptance models were used to develop a thematic coding scheme. Results: Most patients self-identified as Black (67.5%) and female (72.5%), had a mean age of 51 years, lived in an urban area (76.9%), and had Medicaid (57.9%). Most PCPs were White (79.3%) and male (51.7%), had a mean age of 39 years, and reported Medicaid as the predominant insurer (58.6%). Patient use of smartphones for internet access to health and nonhealth activities was common. PCPs noted the need to address misinformation or misinterpretation of information on the internet. Most patients had used a patient portal (72.5%) and noted the convenience of messaging. PCPs reported large increases in messaging workloads. Most patients had had telemedicine visits (65.6%); however, Wi-Fi/broadband problems limited video visits. PCPs expressed concerns regarding the types of chief complaints that are appropriate for telemedicine visits and reported workflow inefficiencies when clinic sessions had mixed visit types. Patients and PCPs valued remote telemonitoring as adjuncts to care; however, limited service availability and insurance coverage were barriers. Conclusion: Infrastructure barriers (broadband, insurance) and workload imbalance temper enthusiasm for using digital health solutions. Health systems should implement complementary patient and provider user-centric strategies for facilitating uptake of technology.

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Section: Introductionmentioning

confidence: 99%

Stop the Divide: Facilitators and Barriers to Uptake of Digital Health Interventions Among Socially Disadvantaged Populations

Price‐Haywood

Arnold

Harden-Barrios

et al. 2023

TOJ

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“…• Limited literature suggests that portals may successfully be used for triaging, scheduling, and monitoring patients with suspected or confirmed COVID-19. [63][64][65] • Offering multimodal (e.g., portal and telephone) approaches was important to avoid disparities. 65 Applied Clinical Informatics Vol.…”

Section: Developing Deploying and Evaluating New Care Processesmentioning

confidence: 99%

“…[63][64][65] • Offering multimodal (e.g., portal and telephone) approaches was important to avoid disparities. 65 Applied Clinical Informatics Vol. 14 No.…”

Section: Developing Deploying and Evaluating New Care Processesmentioning

confidence: 99%

“…56,59 Deploying Tools for COVID-19 Response Three studies investigated how the portal, as important virtual care infrastructure, could be used in the COVID-19 response, particularly for triage and remote monitoring of those diagnosed with COVID-19. [63][64][65] For instance, Judson et al developed and deployed a COVID-19 self-triage and selfscheduling tool through their portal and early evidence showed significant use by patients, high sensitivity for patients with severe disease requiring emergency care, and reduced triage time for patients with less severe disease. 64 Offering multimodal opportunities may be critical to reducing the risk of disparities in uptake and use of COVID-19 response tools.…”

Section: Developing Deploying and Evaluating New Care Processesmentioning

confidence: 99%

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The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

Reynolds,

Cobb,

Steitz

et al. 2023

Appl Clin Inform

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Background and Objective Recent external factors—the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic—have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals. Methods To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses. Results Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities). Conclusion Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.

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“…4,5 The risks of COVID-19 and death are higher among nursing home minority residents, 6 suggesting unequal access to resources and greater exposure to infection. Neighborhood socioeconomic status, including racial/composition of a community, 8,9 per-capita income, 10 housing conditions, 11,12 and the general neighborhood deprivation [13][14][15] are also potential risk factors.…”

mentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19) in assisted living communities: Neighborhood deprivation and state social distancing policies matter

Guo

Temkin‐Greener

2022

Infect. Control Hosp. Epidemiol.

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BACKGROUND: Residents of long-term care facilities face significantly greater risk of contracting or dying from COVID-19. However, little is known about COVID-19 in assisted living communities (ALCs) and the potential determinants of its spread. We examined the association between COVID-19 cases in ALCs and the proportion of Medicare-Medicaid (dual) eligible minority residents, neighborhood area deprivation, and state COVID-19 policy stringency. METHODS: We conducted longitudinal analyses employing data on confirmed COVID-19 cases in ALCs within 5 states. Outcome was weekly cumulative number of COVID-19 cases in ALCs. Covariates were ALC characteristics, area deprivation index, and state COVID-19 policy stringency. Multivariate two-part models were used to determine the associations between independent variables and the likelihood of an outbreak and the overall count of cases. RESULTS: In our study sample, 201 ALCs (7.04%) reported 1 or more COVID-19 cases as of August 17th, 2020. A higher percentage of minority residents was associated with an increased likelihood of ALC reporting at least one COVID-19 case (OR=1.06, P=0.032). Conditional on having at least one case, ALCs in states with stricter social distancing policies had lower case count (IRR=0.98, P<0.001). Greater neighborhood deprivation was associated with higher case count (IRR=1.36, P=0.049). CONCLUSION: ALCs with higher proportions of dual-eligible minority residents were more likely to have COVID-19 outbreaks within their communities. ALCs located in more socioeconomically deprived neighborhoods, and in states with less stringent state social distancing policies tended to have more COVID-19 cases.

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Association of Race and Neighborhood Disadvantage with Patient Engagement in a Home-Based COVID-19 Remote Monitoring Program

Cited by 11 publications

References 30 publications

Stop the Divide: Facilitators and Barriers to Uptake of Digital Health Interventions Among Socially Disadvantaged Populations

Stop the Divide: Facilitators and Barriers to Uptake of Digital Health Interventions Among Socially Disadvantaged Populations

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

Coronavirus disease 2019 (COVID-19) in assisted living communities: Neighborhood deprivation and state social distancing policies matter

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