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. 2021 Dec 7;23(12):e28503.
doi: 10.2196/28503.

Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review

James E Bailey #  1 , Cathy Gurgol  2 , Eric Pan  3 , Shirilyn Njie  3 , Susan Emmett  4 , Justin Gatwood  5 , Lynne Gauthier  6 , Lisa G Rosas  7   8 , Shannon M Kearney  9 , Samantha Kleindienst Robler  10 , Raymona H Lawrence  11 , Karen L Margolis  12 , Ifeyinwa Osunkwo  13 , Denise Wilfley  14 , Vallabh O Shah  15
Affiliations

Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review

James E Bailey et al. J Med Internet Res. .

Abstract

Background: Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities.

Objective: This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities.

Methods: A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study.

Results: PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information.

Conclusions: Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.

Keywords: disparities; implementation science; scoping review; telehealth.

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Conflict of interest statement

Conflicts of Interest: All listed authors are either investigators associated with Patient-Centered Outcomes Research Institute (PCORI)-funded studies in its specific telehealth portfolio, PCORI employees, or PCORI contractors/consultants. All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, or its Board of Governors or Methodology Committee.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews flow diagram of the study selection process. PCORI: Patient-Centered Outcomes Research Institute.
Figure 2
Figure 2
Patient-Centered Outcomes Research Institute comparative effectiveness studies assessing telehealth solutions to address disparaties.
Figure 3
Figure 3
Populations at risk of disparities targeted by Patient-Centered Outcomes Institute comparative effectiveness studies in telehealth.
See this image and copyright information in PMC

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