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Smith DC, Thumm EB, Anderson J, Kissler K, Reed SM, Centi SM, Staley AW, Hernandez TL, Barton AJ. Sudden Shift to Telehealth in COVID-19: A Retrospective Cohort Study of Disparities in Use of Telehealth for Prenatal Care in a Large Midwifery Service. J Midwifery Womens Health 2024; 69:522-530. [PMID: 38111228 PMCID: PMC11182882 DOI: 10.1111/jmwh.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/26/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid-March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider-patient messaging, telephone visits, and video visits) during the COVID-19 pandemic among those receiving care in a large, academic nurse-midwifery service. METHODS We conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse-midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in-person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID-19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors. RESULTS When comparing pre-COVID-19 (before March 2020) with during COVID-19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (P < .001). The increase was driven by telehealth encounters; there were no significant differences for in-person prenatal visit counts before and during the pandemic period. Direct patient-provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression. DISCUSSION No differences in the frequency of in-person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in-person encounters. Spanish-speaking patients were least likely to use telehealth-delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload.
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Affiliation(s)
- Denise C. Smith
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - E. Brie Thumm
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Jessica Anderson
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Katherine Kissler
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Sean M. Reed
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Sophia M. Centi
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Alyse W. Staley
- Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, Colorado, USA
- University of Colorado Cancer Center, Biostatistics Core, Aurora, Colorado, USA
| | - Teri L. Hernandez
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism, & Diabetes, Aurora, Colorado, USA
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amy J. Barton
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
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Fareed N, Swoboda C, Singh P, Boettcher E, Wang Y, Venkatesh K, Strouse R. Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: Mixed-methods study. Digit Health 2023; 9:20552076221144181. [PMID: 36644662 PMCID: PMC9834416 DOI: 10.1177/20552076221144181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/21/2022] [Indexed: 01/11/2023] Open
Abstract
Background A tailored and integrated technology solution (patient mHealth application and provider dashboard) can provide a 360° view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy that could improve health outcomes and address health inequities. Objectives To develop a set of user specifications for the mHealth and dashboard applications, develop prototypes based on user needs, and collect initial impressions of the prototypes to subsequently develop refined tools that are ready for deployment. Methods Study activities followed a double-diamond framework with a participatory design mindset. Activities were divided into two phases focused on a qualitative inquiry about participant needs and values (phase 1) and design, development, and usability testing of low and high-fidelity prototypes (phase 2). Results We identified themes that exemplified pregnancy experience among Medicaid-enrolled individuals with T2D. Patients (n = 7) and providers (n = 7) expressed a core set of expectations for the mHealth and dashboard applications. Participants provided feedback to improve the mHealth and dashboard. For both applications, participants reported scores for the NASA Task load Survey (TLX) that were in the 20th percentile of national TLX scores. Conclusions Digital health tools have the ability to transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels, which is a precursor to experiencing a successful pregnancy and birth. Distilling patient and provider needs and preferences-then using them, along with prior studies and theory, to develop applications-holds great potential in tackling complicated health care issues.
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Affiliation(s)
- Naleef Fareed
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, OH, USA,Naleef Fareed, 460 Medical Center Drive, Columbus, OH 43210, USA.
| | - Christine Swoboda
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, OH, USA
| | - Priti Singh
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, OH, USA
| | - Emma Boettcher
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Yiting Wang
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kartik Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Robert Strouse
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, USA
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Xu NY, Nguyen KT, DuBord AY, Pickup J, Sherr JL, Teymourian H, Cengiz E, Ginsberg BH, Cobelli C, Ahn D, Bellazzi R, Bequette BW, Gandrud Pickett L, Parks L, Spanakis EK, Masharani U, Akturk HK, Melish JS, Kim S, Kang GE, Klonoff DC. Diabetes Technology Meeting 2021. J Diabetes Sci Technol 2022; 16:1016-1056. [PMID: 35499170 PMCID: PMC9264449 DOI: 10.1177/19322968221090279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 4 to November 6, 2021. This meeting brought together speakers to discuss various developments within the field of diabetes technology. Meeting topics included blood glucose monitoring, continuous glucose monitoring, novel sensors, direct-to-consumer telehealth, metrics for glycemia, software for diabetes, regulation of diabetes technology, diabetes data science, artificial pancreas, novel insulins, insulin delivery, skin trauma, metabesity, precision diabetes, diversity in diabetes technology, use of diabetes technology in pregnancy, and green diabetes. A live demonstration on a mobile app to monitor diabetic foot wounds was presented.
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Affiliation(s)
- Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | | | | | | | | | - Eda Cengiz
- University of California, San
Francisco, San Francisco, CA, USA
| | | | | | - David Ahn
- Mary & Dick Allen Diabetes Center
at Hoag, Newport Beach, CA, USA
| | | | | | | | - Linda Parks
- University of California, San
Francisco, San Francisco, CA, USA
| | - Elias K. Spanakis
- Baltimore VA Medical Center,
Baltimore, MD, USA
- University of Maryland, Baltimore,
MD, USA
| | - Umesh Masharani
- University of California, San
Francisco, San Francisco, CA, USA
| | - Halis K. Akturk
- Barbara Davis Center for Diabetes,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Sarah Kim
- University of California, San
Francisco, San Francisco, CA, USA
| | - Gu Eon Kang
- The University of Texas at Dallas,
Richardson, TX, USA
| | - David C. Klonoff
- Diabetes Research Institute,
Mills-Peninsula Medical Center, San Mateo, CA, USA
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Morgan E, Schnell P, Singh P, Fareed N. Outpatient portal use among pregnant individuals: Cross-sectional, temporal, and cluster analysis of use. Digit Health 2022; 8:20552076221109553. [PMID: 35837662 PMCID: PMC9274807 DOI: 10.1177/20552076221109553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Outpatient portal technology can improve patient engagement. For pregnant individuals, the level of engagement could have important implications for maternal and infant outcomes. Objective This study: (1) cross-sectionally and temporally characterized the outpatient portal use among pregnant individuals seen at our academic medical center; and (2) identified clusters of the outpatient portal user groups based on the cross-sectional and temporal patterns of use. Methods We used outpatient portal server-side log files to execute a hierarchical clustering algorithm to group 7663 pregnant individuals based on proportions of outpatient portal function use. Post-hoc analyses were performed to further assess outpatient portal use on key encounter characteristics. Results The most frequently used functions were MyRecord (access personal health information), Visits (manage appointments), Messaging (send/receive messages), and Billing (view bills, insurance information). Median outpatient portal function use plateaued by the third trimester. Four distinct clusters were identified among all pregnant individuals: “Schedulers,” “Resulters,” “Intense Digital Engagers,” and “Average Users.” Post-hoc analyses revealed that the use of the Visits function increased and the use of the MyRecord function decreased over time among clusters. Conclusions Our identification of distinct cluster groups of outpatient portal users among pregnant individuals underscores the importance of avoiding the use of generalizations when describing how such patients might engage with patient-facing technologies such as an outpatient portal. These results can be used to improve user experience and training with outpatient portal functions and may educate maternal health providers on patient engagement with the outpatient portal.
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Affiliation(s)
- Evan Morgan
- Department of Biomedical Informatics, The Ohio State University, USA
| | | | - Priti Singh
- Department of Biomedical Informatics, The Ohio State University, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, The Ohio State University, USA
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Holder K, Ukoha E, Feinglass J, Yee LM. Relationship Between Patient Portal Utilization and Glycemic Control Outcomes During Pregnancy. J Diabetes Sci Technol 2021; 15:970-971. [PMID: 33736473 PMCID: PMC8258507 DOI: 10.1177/1932296821998742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kai Holder
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erinma Ukoha
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Joe Feinglass
- Department of Medicine Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Lynn M. Yee, MD, MPH, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E Superior Street, #5-2145, Chicago, IL 60611, USA.
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Ukoha EP, Feinglass J, Yee LM. Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study. J Med Internet Res 2019; 21:e14445. [PMID: 31586367 PMCID: PMC6818527 DOI: 10.2196/14445] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 01/20/2023] Open
Abstract
Background Electronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure Web-based platform. These portals are becoming increasingly popular in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, especially in the management of chronic disease. However, disparities have been identified in portal use in which racial and ethnic minorities and individuals with lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and individuals with higher socioeconomic status. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited. Objective This study aimed to quantify the use of an electronic patient portal during pregnancy and examine whether disparities related to patients’ demographics or clinical characteristics exist. Methods This was a retrospective cohort study of women who received prenatal care at an academic medical center from 2014 to 2016. Clinical records were reviewed for portal use and patient data. Patients were considered enrolled in the portal if they had an account at the time of delivery, and enrollees were compared with nonenrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (≥1) or inactive (0) users. Bivariable chi-square and multivariable Poisson regression models were used to calculate the incidence rate ratio of portal enrollment and, if enrolled, of active use based on patients’ characteristics. Results Of the 3450 women eligible for inclusion, 2530 (73.33%) enrolled in the portal. Of these enrollees, 72.09% (1824/2530) were active users. There was no difference in portal enrollment by maternal race and ethnicity on multivariable models. Women with public insurance (adjusted incidence rate ratio; aIRR 0.60, 95% CI 0.49-0.84), late enrollment in prenatal care (aIRR 0.78, 95% CI 0.69-0.89 for second trimester and aIRR 0.50, 95% CI 0.39-0.64 for third trimester), and high-risk pregnancies (aIRR 0.82, 95% CI 0.75-0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10, 95% CI 1.02-1.20) and having more than 8 prescription medications at prenatal care initiation (aIRR 1.19, 95% CI 1.06-1.32) were associated with greater likelihood of enrollment. Among portal enrollees, the only factor significantly associated with active portal use (ie, secure messaging) was nulliparity (aIRR 1.11, 95% CI 1.01-1.23). Conclusions Among an obstetric population, multiple clinical and socioeconomic factors were associated with electronic portal enrollment, but not subsequent active use. As portals become more integrated as tools to promote health, efforts should be made to ensure that already vulnerable populations are not further disadvantaged with regard to electronic-based care.
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Affiliation(s)
- Erinma P Ukoha
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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