TELE Para DM: Telemedicine Equity for Limited English Proficient Patients with Diabetes Mellitus in the Safety Net

TELE Para DM：安全网中英语水平有限的糖尿病患者的远程医疗公平性

基本信息

批准号：
10598472
负责人：
ALEJANDRA CASILLAS
金额：
--
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-30 至 2023-04-19
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10598472
关键词：
Address Adoption Affect Amendment Area Award COVID-19 pandemic Caring Chronic Chronic Disease Clinic Clinical Collaborations Communities County Diabetes Mellitus Disparity Education Educational Intervention Effectiveness Ensure Equity Evaluation Evidence based intervention Face Family Goals Health Health Disparities Research Health Educators Health Services Health Services Accessibility Health Status Health Technology Health system Healthcare Healthcare Systems Improve Access Individual Inequity Institute of Medicine (U.S.)Institution Intervention Intervention Trial Interview Knowledge Language Left Limited English Proficiency Linguistics Los Angeles Low income Measures Medicaid Mentorship Methods Modeling Monitor National Institute on Minority Health and Health Disparities Outcome Patient Care Patients Persons Populations at Risk Positioning Attribute Primary Care Primary Care Physician Quality of Care Randomized, Controlled Trials Reduce health disparities Registries Research Research Personnel Research Priority Role Self Care Self Management Services Site Structure Surface System Telemedicine Telephone Testing Time Training Uninsured United States Visit Vulnerable Populations barrier to care bilingualism career cost design diabetic diabetic patient digital digital health disorder control ethnic minority evidence base experience health care availability health disparity implementation framework implementation intervention implementation science improved innovation literacy novel patient oriented patient population patient portal patient registry pilot test pilot trial post intervention primary care clinic primary care patient primary care setting primary care visit primary health service racial minority safety net skills social theories therapy design tool treatment arm trend uptake virtual health services virtual healthcare

项目摘要

Project Summary/Abstract Telemedicine (remote telephone and video health visits) is a digital health tool that can increase access to care and improve health outcomes. Telemedicine care has been critical to maintaining healthcare access when in- person care is disrupted, and the arrival of the Coronavirus-19 disease (COVID-19) pandemic forced the integration of telemedicine into care almost overnight. But this is problematic for safety net health systems who disproportionately provide care to racial/ethnic minority and Limited English Proficient (LEP) patients, who have faced significant barriers with past digital health technology. In this K23, we will study telemedicine in the Los Angeles County Department of Health Services (LAC DHS)— the second largest safety net in the United States. We will focus on a particularly vulnerable population with need for frequent, interval care: patients with diabetes mellitus (DM), specifically addressing LEP Spanish-speakers, who are 62% of the DM patients at LAC DHS. This K23 proposal will investigate differences in factors affecting telemedicine use and explore associated quality of diabetic care via quantitative and qualitative analyses among Spanish- and English- speaking primary care patients (Aim 1). In partnership with the LAC DHS Virtual Care Workgroup, these analyses will inform the tailored design of a patient coaching intervention in Spanish and in English to increase and facilitate telemedicine use (Aim 2) and a pilot randomized controlled trial of the bilingual intervention (Aim 3). These aims will be achieved using mixed methods, implementation science, and digital health disparities conceptual frameworks as they address the NIMHD research priority areas of developing interventions to improve access to care for vulnerable patients and reduce health disparities. The studies are novel given the timely focus on telemedicine implementation for vulnerable patient populations, addressing LEP patients explicitly, as well as the proposed use of mixed methods to develop a theory-driven intervention. The proposed studies are informed by Dr. Alejandra Casillas’ role as a primary care physician and her patient portal research experience in diverse, urban primary care settings. Dr. Casillas’ long-term goal is to develop interventions that reduce digital health disparities, increase health access, and improve health outcomes for racial/ethnic minority and LEP patients. During the course of this award, Dr. Casillas will undertake didactic and experiential training to improve knowledge and skills in three areas: (1) mixed methods in digital health disparities research, (2) telemedicine delivery in the safety net, and (3) evaluation of pilot trial interventions in real-world clinical settings using implementation science methods. Dr. Casillas has assembled a multi-institutional mentorship team with the complementary expertise to ensure completion of the proposed research and training and successful transition to independence. This K23 will position Dr. Casillas, as an early career investigator, to develop a NIMHD-R01 for other languages and chronic disease conditions: findings could result in widespread adoption of this model as an evidence-based intervention to augment telemedicine for vulnerable patients in the US.

项目概要/摘要远程医疗（远程电话和视频健康就诊）是一种数字健康工具，可以增加获得护理的机会并改善健康状况。远程医疗对于维持医疗服务的可及性至关重要。个人护理受到干扰，冠状病毒 (Coronavirus-19) 疾病 (COVID-19) 大流行的到来迫使远程医疗几乎在一夜之间融入护理，但这对于安全网卫生系统来说是个问题。不成比例地为少数族裔和英语水平有限 (LEP) 患者提供护理，他们过去的数字医疗技术面临重大障碍在本次 K23 中，我们将研究洛杉矶的远程医疗。安吉利斯县卫生服务部 (LAC DHS) — 美国第二大安全网我们将重点关注需要频繁、间隔护理的特别脆弱人群：患有以下疾病的患者：糖尿病 (DM)，特别针对说西班牙语的 LEP，他们占 LAC DM 患者的 62% DHS 的这项 K23 提案将调查影响远程医疗使用的因素的差异并进行探索。通过西班牙语和英语之间的定量和定性分析来确定糖尿病护理的相关质量会说话的初级保健患者（目标 1）与 LAC DHS 虚拟护理工作组合作，为这些患者提供服务。分析将为西班牙语和英语患者辅导干预的定制设计提供信息，以提高并促进远程医疗的使用（目标 2）和双语干预的试点随机对照试验（目标 3). 这些目标将通过混合方法、实施科学和数字健康差异来实现。概念框架，因为它们涉及 NIMHD 研究的优先领域，即制定干预措施鉴于以下情况，这些研究具有新颖性：改善弱势患者获得护理的机会并减少健康差距。及时关注弱势患者群体的远程医疗实施，解决 LEP 患者的问题明确地，以及建议使用混合方法来制定理论驱动的干预措施。亚历杭德拉·卡西利亚斯 (Alejandra Casillas) 博士作为初级保健医生的角色及其患者门户研究为研究提供了信息卡西利亚斯博士的长期目标是制定干预措施，以实现多样化的城市初级保健环境。减少数字健康差异，增加医疗服务的可及性，并改善少数种族/族裔的健康结果在此奖项期间，卡西利亚斯博士将接受教学和体验式培训。提高三个领域的知识和技能：(1) 数字健康差异研究的混合方法，(2) 安全网中的远程医疗交付，以及（3）在现实临床环境中评估试点试验干预措施卡西利亚斯博士使用实施科学方法组建了一个多机构指导团队。互补的专业知识，以确保完成拟议的研究和培训并取得成功过渡到独立。卡西利亚斯博士将作为一名早期职业调查员，开发一种 NIMHD-R01 适用于其他语言和慢性疾病：研究结果可能会导致广泛采用该模型作为一种基于证据的干预措施，旨在增强美国弱势患者的远程医疗。