Community Health Centers Uptake of Telemedicine During the COVID-19 Pandemic: Trends, Barriers, and Successful Strategies.

IF 3 Q1 PRIMARY HEALTH CARE Journal of Primary Care and Community Health Pub Date : 2024-01-01 DOI:10.1177/21501319241274351
Heather Holderness, Andrea Baron, Tahlia Hodes, Miguel Marino, Jean O'Malley, Maria Danna, Deborah J Cohen, Nathalie Huguet
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Abstract

Objective: To describe telemedicine use patterns and understand clinic's approaches to shifting care delivery during the COVID-19 pandemic.

Methods: We used electronic health record data from 203 community health centers across 13 states between 01/01/2019 and 6/31/2021 to describe trends in telemedicine visit rates over time. Qualitative data were collected from 13 of those community health centers to understand factors influencing adoption and implementation of telemedicine.

Results: Most clinics in our sample were in urban areas (n = 176) and served a majority of uninsured and publicly insured patients (12.8% and 44.4%, respectively) across racial and ethnic minority groups (16.6% Black and 29.3% Hispanic). During our analysis period there was a 791% increase in telemedicine visits from before the pandemic (.06% pre- vs 47.5% during). A latent class growth analysis was used to examine differences in patterns of adoption of telemedicine across the 203 CHCs. The model resulted in 6 clusters representing various levels of telemedicine adoption. A mixed methods approach streamlined these clusters into 4 final groups. Clinics that reported rapid adoption of telemedicine attributed this change to leadership prioritization of telemedicine, robust quality improvement processes (eg, using PDSA processes), and emphasis on training and technology support.

Conclusions: In response to the COVID-19 pandemic, telemedicine adoption rates varied across clinics. Our study highlight that organizational factors contributed to the clinic's ability to rapidly uptake and use telemedicine services throughout the pandemic. These approaches could inform future non-pandemic practice change and care delivery.

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社区卫生中心在 COVID-19 大流行期间采用远程医疗:趋势、障碍和成功策略。
目的描述远程医疗的使用模式,了解诊所在 COVID-19 大流行期间转移医疗服务的方法:我们使用 13 个州 203 家社区医疗中心在 2019 年 1 月 1 日至 2021 年 6 月 31 日期间的电子健康记录数据来描述远程医疗就诊率随时间变化的趋势。我们从其中 13 个社区卫生中心收集了定性数据,以了解影响远程医疗采用和实施的因素:我们样本中的大多数诊所都位于城市地区(n = 176),为大多数无保险和有公共保险的患者提供服务(分别为 12.8% 和 44.4%),涉及少数种族和族裔群体(16.6% 为黑人,29.3% 为西班牙裔)。在我们的分析期间,远程医疗就诊人数比大流行前增加了 791%(大流行前为 0.06%,大流行期间为 47.5%)。我们采用了潜类增长分析来研究 203 家社区健康中心采用远程医疗模式的差异。该模型产生了 6 个代表不同远程医疗采用水平的群组。采用混合方法将这些群组精简为 4 个最终组别。报告快速采用远程医疗的诊所将这一变化归功于领导层对远程医疗的优先考虑、强有力的质量改进流程(如使用 PDSA 流程)以及对培训和技术支持的重视:为应对 COVID-19 大流行,各诊所采用远程医疗的比例各不相同。我们的研究强调,组织因素有助于诊所在整个大流行期间快速吸收和使用远程医疗服务。这些方法可为未来非大流行病的实践变革和医疗服务提供参考。
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来源期刊
CiteScore
4.80
自引率
2.80%
发文量
183
审稿时长
15 weeks
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