Building upon a Single Intervention in a Spanish-Speaking Population to Enhance Access to Telemedicine in Pediatric Epilepsy
Abstract number :
3.373
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2023
Submission ID :
1021
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Bianca Kapoor-heaphy, MD – Children's Hospital of Philadelphia
Pamela Pojomovsky McDonnell, MD – Children's Hospital of Philadelphia; Yessenia Ortiz, . – Children's Hospital of Philadelphia; Sara Molisani, MD – Children's Hospital of Philadelphia; Mark Ramos, BS – Children's Hospital of Philadelphia; Michael Kaufman, MS – Children's Hospital of Philadelphia; Mark Fitzgerald, MD, PhD – Children's Hospital of Philadelphia; Alexander Gonzalez, MS, MBA – Children's Hospital of Philadelphia; Nicholas Abend, MD, MSCE – Children's Hospital of Philadelphia; Ingo Helbig, MD – Children's Hospital of Philadelphia
Rationale: Since the COVID-19 pandemic and the 21st Century Cures Act, telehealth and electronic access to medical records became increasingly available and important to access care. Historically, non-English speaking families and patients had decreased use of these services (Gursky, T. et al., 2021; Kaufman, M. et al., 2021). Spanish speaking families face barriers to healthcare access, particularly with lower rates of telemedicine encounters (Rametta, S. et al., 2020). In a prior quality improvement initiative, we demonstrated that a single intervention expanded access to the electronic patient portal and thus telemedicine access. In this quality improvement study, we aimed to expand this single intervention to multiple providers. As a secondary aim, we sought to create a dashboard to track activation by language across the division.
Methods: This study targeted Spanish-speaking families without electronic patient portal access seen in at a single pediatric neurology clinic. The intervention consisted of written instructions in Spanish before and during the visit, prompting of providers to ask about portal access at the end of the visit, and direction to ask for help from the front desk at the end of the visit if needed. We performed two rounds of intervention (1) provision by one Spanish-speaking provider; and (2) provision by six Spanish and non-Spanish speaking providers. Chart review assessed rates of activation, use of the portal (telemedicine, view results, and send messages).
Results: The first cycle consisted of 17 patients over 16 months (Mar 2021 through July 2022). After the intervention, 71% (12/17) had the portal activated with 83% (10/12) of those users accessing the portal subsequently. The second cycle consisted of 12 patients over 7 months (July 2022 through May 2023). Initial patient activation rate consisted of 58% (7/12) with 86% (6/7) of those users accessing the portal subsequently. Rates of portal use (telemedicine, view results, and send message) were similar in both interventions (Fig. 1). The dashboard shows monthly activation rates across the neurology department, starting in August 2019 (Fig. 2).
Conclusions: Our intervention performed by a single provider demonstrated a high activation rate of patient portal activation and portal use. Upon scaling to multiple providers, activation remained high (although lower than when the intervention was provided by a single Spanish-speaking provider) and a similar proportion of patients with the portal activated used the portal. These data indicate that a simple intervention (directions, provider inquiry, and front desk help) often achieved portal activation, and patients with the portal activated usually used it. Further studies will assess increased scaling and potential issues with intervention fidelity which may have led to lower efficacy in the second phase. Throughout this time, there remains a persistent gap in active patient portals for Spanish speaking families which we hope to explore with further initiatives.
Funding: AAN IDEAS project grant
Health Services (Delivery of Care, Access to Care, Health Care Models)