1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
Has Increased Utilization of Telehealth Resulted in Higher Quality Healthcare Outcomes in Communities of Color
Studies have shown that low-income patients, patients from communities of color, and those patients who do not speak English as their first language have less internet access and lower technology literacy. They may also not place trust in new modes of healthcare delivery. A 2021 federal report among the Medicare population showed Black and rural beneficiaries used telehealth less often than whites and urban dwellers. Even where Black Americans utilized telehealth, those living in lower-income areas were more likely to engage in audio-only telephone visits while patients who were white and from higher-income areas were more likely to engage in video visits, raising questions about quality of care and related health outcomes.
A recent NIH study likewise showed that video visits were "significantly lower" for patients 65 and older, male, Black, Indigenous, prefer a language other than English, or enrolled in Medicaid or Medicare and (2) patients who were ages 65 and older, Black or non-English speaking were more reliant on telephone visits than video visits.
Has Telehealth Use Impacted the Quality and Safety of Healthcare Delivery
To date, the most available research on telemedicine has been focused on the use of virtual care for maintenance of health, but use of telemedicine for diagnosis – telediagnosis – at this scale is unprecedented, “creating more unknowns than knowns about its impact on diagnostic quality and safety” according to researchers from the Society to Improve Diagnosis in Medicine released an issue brief entitled Improving TeleDiagnosis: A Call to Action. Certain clues about a patient’s condition, lifestyle or response to a new medication may be hard to see via video and nearly impossible to perceive over the phone.
The former Acting Director of AHRQ also recognized the need to further assess the impact on health equity, stating, “Although overall visit volumes remained about the same from the pre-pandemic to the pandemic study periods, the share of audio-only and video visits dramatically increased during the pandemic, particularly for behavioral health.”
PPATH recognizes that telehealth may cause treatment challenges for some patient. For example, telehealth may not be an appropriate substitute for patients who would benefit most from an in-person care. Certain conditions require an in-person visit in order to recognize symptoms and side effects that may not be visible in a telehealth visit. Other visits that require diagnostic testing may also require in-person care.
2. Why are you struggling with this issue?
Has Increased Utilization of Telehealth Resulted in Higher Quality Healthcare Outcomes in Communities of Color
More studies to examine the affect telehealth has on health disparities – particularly how sociodemographic factors may influence the effectiveness of a telehealth visit – should be conducted. PPATH therefore encourages the EPC program to undertake a study on health outcomes of telehealth in minority populations.
Has Telehealth Use Impacted the Quality and Safety of Healthcare Delivery
As policymakers wrestle with decisions about the permanency of telehealth expansion, greater study about the correlation between telehealth expansion and health outcomes in terms of quality and safety should be studied.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
See supporting documentation attached.
4. When do you need the evidence report?
Friday, 12/01/2023
5. What will you do with the evidence report?
See supporting documentation attached.
Supporting Documentation
Impacts of Telehealth Utilization in Communities of Color Supplement (pdf, 177 KB)
Optional Information About You
What is your role or perspective? Patient Advocacy Organization
If you are you making a suggestion on behalf of an organization, please state the name of the organization. Patient & Provider Advocates for Telehealth
May we contact you if we have questions about your nomination? Yes
