A recent study in the Journal of the American Medical Informatics Association found a significant association between the use of telehealth services and health care access and outcomes. improved in communities negatively impacted by health disparities.
But to truly achieve those quality improvements – while also addressing the social determinants of health challenges and cutting costs – virtual care needs to be delivered with a a little more hands-on, says Dr. Rahul Sharma, director of emergency medicine at NewYork- said. Presbyterian/Weill Cornell Medical Center.
Sharma is the main author of that JAMIA reports – with colleagues Dr. Brock Daniels, Christina McGinnis, Leah Shafran Topaz, Dr. Peter Greenwald, Meghan Reading Turchioe, RN, and Ruth Marie Masterson Creber, RN. It describes the value of a mobile-enabled, integrated telehealth program that combines home health aide visits with video consultations with emergency physicians.
We interviewed Dr. Sharma to explore the correlation between socioeconomic need and higher chronic disease burden, and how increasing telehealth services can address and reduce the gap This.
We also discuss differences in telehealth needs, conditions, and behaviors between communities facing few health disparities and those facing significant disparities. And we learned how NewYork-Presbyterian/Weill Cornell Medical Center telehealth services are improving health literacy and outcomes in communities disproportionately impacted by the difference.
Q. What is the correlation between socioeconomic needs (high unemployment, rent burden, limited English proficiency, etc.) and higher chronic disease burden? How can increased telehealth services address and reduce this gap?
ONE. Health disparities are closely linked to the social determinants of health, which can be defined as the conditions in the environment where people are born, live, learn, work, and play. play, worship and age affect many types of health, function and quality of- life outcomes and risks. People living in areas adversely affected by SDOH not only have higher rates of chronic disease but also tend to have worse clinical outcomes.
For example, factors such as low educational attainment, poor diet, smoking and insufficient exercise can contribute to the development of heart disease. These factors, exacerbated by unstable living conditions and low insurance, often lead to inadequate medical follow-up, difficulty adhering to treatment plans, and ultimately premature death. compared to patients with similar heart disease.
These patients also had more avoidable health care utilization, such as more frequent emergency department visits, hospitalizations, and 30-day readmissions.
Although adverse SDOH contribute differently to clinical outcomes, the more adverse SDOH a person experiences, the less likely they are to receive quality health care. Telehealth has the potential to improve access to timely, high-quality care by reducing the need for travel and providing more flexible appointment scheduling.
However, the promise of telehealth has not yet been fully realized, especially in populations with the greatest health inequities. In many cases, the same factors that lead to poor health outcomes and poor access to care also contribute to low use of digital health services.
For example, web-based services and apps require hardware such as smartphones and broadband Internet, as well as a certain level of health and digital literacy. Furthermore, competing necessities such as rent, food, and child care often take on greater importance in communities negatively impacted by adverse SDOH.
Therefore, it is important for health systems to increase telehealth delivery capabilities and conduct needs assessments in target populations to thoughtfully design health services. Digital health aims to solve problems that video visits alone cannot solve.
Q. What are the differences in telehealth needs, conditions, and behaviors between communities with few health disparities and those facing significant disparities?
ONE. Care-seeking behaviors, type and stage of condition requiring care, and logistical or technical needs vary significantly among communities facing significant health disparities. health compared to communities that do not. Competing demands and lower levels of health literacy often lead to delays in accessing care.
As a result, patients living in communities with greater health care disparities often have more severe or severe illness.
People living in communities with lower health care disparities use telehealth more often for minor problems such as uncomplicated upper respiratory tract infections or routine primary care follow-ups, compared to For people in areas with high health care disparities, people with multiple chronic diseases often receive inadequate treatment.
Finally, while access to broadband and video-capable devices is increasing across the United States, access to this technology and the level of proficiency required does not always mean the use of that technology for health care.
It is clear that characteristics such as older age, chronic illness, lower income, gender, and ethnicity are associated with lower likelihood of using telehealth, but the reasons for this remain unclear. Two potential factors are: 1) Knowing the right situation to use telehealth services and 2) Trusting that you will receive appropriate care using digital health.
For example, one study found that black patients were four times more likely than white patients to seek in-person care versus use telehealth for urgent care claims related to COVID-19 similar. Furthermore, trust in the health system and providers facilitates appropriate care-seeking behavior; Developing trust is more difficult when care is delivered virtually.
Q. How have your telehealth services improved health knowledge and outcomes in communities disproportionately impacted by disparities?
ONE. NewYork-Presbyterian and Weill Cornell Medicine have launched Community Tele-Paramedicine, a mobile-integrated form of telehealth to deliver acute and chronic care to the largely underserved population. healthcare in 2019.
Since then, we’ve conducted more than 5,000 home polls. Visits patients throughout the NewYork-Presbyterian hospital network, helping to reduce unnecessary emergency department visits and unplanned readmissions within 30 days of discharge.
At its core, CTP is Telemedicine is facilitated. We enroll patients at risk for preventable health care utilization, many of whom live in communities negatively impacted by adverse SDOH, and proactively engage with them through nurse care managers. By identifying gaps in care and symptoms early, the CTP team can intervene and prevent a patient’s condition from deteriorating to the point where 911 is the only option.
For example, if a patient with heart failure misses an appointment because of lack of transportation, runs out of medication because they cannot afford it, or begins to retain fluids and has more difficulty breathing, our team can identify these issues , as any remote monitoring program can intervene in the home, something that most traditional remote monitoring or standard telehealth programs cannot do.
Our team of community health workers, who have received additional training in chronic disease management, motivational interviewing, and facilitation of telehealth encounters, carry all necessary equipment to come home for a video visit with the ED physician. Doctors may evaluate leg swelling, listen to lung sounds, collect vital signs, perform diagnostic tests, and administer intravenous medications to treat symptoms under supervision. virtual by our ED physicians.
NewYork-Presbyterian care managers can arrange transportation to appointments, order medication packages, and recommend in-home services. Assisted telehealth provides a perspective on a patient’s life and living conditions, allowing for disease education that is more contextual and oriented to that patient’s circumstances. Those circumstances may not be immediately apparent if the same encounter were conducted in an emergency room or primary care office.
Anonymous surveys were filled out by CTP patients found that more than 90% agreed that they had a better understanding of how to take their medications, knew when to schedule follow-up appointments, felt less anxious about returning to the hospital, and that the CTP provided the same quality of care as coming to the hospital institute .
We also conducted in-depth qualitative interviews with CTP participants to better understand how participating in the program has impacted their care. Patients living in communities with high health disparities frequently report improved understanding of their chronic conditions and greater confidence in their ability to manage those conditions.
Interestingly, when the thematic data were analyzed by the level of disparities in the community in which they lived, people in lower disparities areas were more likely to describe CTP as a “more convenient option” for care directly, while a common theme among them was that areas with higher disparities considered CTP an essential part of their care.
Q. Why is health engagement so important in high-disparity communities?
ONE. Another theme that emerged from our qualitative research is that chronic disease patients in high-disparity areas consistently identify CTP as a sign of a cohesive health system that cares about them and their health. Proactive outreach and digital-first care options deliver more interactions at a lower cost, are more convenient and efficient, and have the potential to drive patient loyalty.
Supported telehealth visits build trust, promote patient-centered care, and enable providers to simultaneously assess and intervene using an at-home component , while maximizing the efficiency of the more expensive virtual doctor.
The key to the program’s success is undoubtedly our community health workers. As trusted community members, they have the respect and credibility necessary to engage with patients in high- and low-disparity communities.
And although our program uses community health workers, other community health workers such as visiting nurses, home health aides, and community health workers may also similarly employed to support telehealth, depending on the program’s required scope of practice and local regulations.
Ultimately, healthcare engagement benefits both health systems and patients when it results in higher quality care, better outcomes, improved patient loyalty, and lower cost.
While creating favorable conditions telemedicine programs have higher capital and operating costs and are limited in scalability compared to non-traditional telemedicine programs, if implemented in the right financial environment, such as self-insured or risk-shared care organizations and targeting most patient groups. have the potential to benefit as algorithmically identified high-need, high-cost groups with high levels of safely preventable health care utilization, they may is cost effective.
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