Telemedicine for Patients with Limited English Proficiency: A Mixed Methods Approach to Identifying and Addressing Disparities

PROJECT ABSTRACT/SUMMARY Patients with limited English proficiency (LEP) are defined as “those who cannot effectively communicate in English”, make up nearly 9% of the U.S. patient population.13 Patients with LEP are one of the groups most underserved by the U.S. health system. They experience poorer access to care, face worse quality and safety outcomes, and report lower levels of satisfaction with their care.14–16,18 Utilization of telemedicine, the provision of remote clinical services via two-way synchronous communication, has demonstrated efficacy in certain settings and has been proposed as a general means for reducing health disparities. 1–4 5 However, studies prior to the COVID-19 pandemic have indicated patients with LEP also face disparities in accessing telemedicine-based care.20–23 As the COVID-19 pandemic continues, it is clear that telemedicine will remain part of the U.S. health system,11,12 therefore it is essential to assess how social determinants of health may affect vulnerable groups’ ability to receive equitable telemedicine-based services. We propose a mixed methods sequential explanatory design approach to identify and address barriers and facilitators related to providing telemedicine care to patients with LEP, with a focus on the intersection of other social determinants of health. Our approach will allow us to determine what may quantitatively drive disparities in utilization, which will then inform a qualitative assessment why these disparities exist and how they may be resolved.25 The specific aims are to 1) perform a longitudinal, retrospective analysis comparing telemedicine utilization and total outpatient utilization, prior to and during the COVID-19 pandemic by LEP patients to that of English proficient patients, 2) to qualitatively investigate how telemedicine visits are provided to patients with LEP through semi-structured interviews with healthcare professionals working/interacting with LEP patients (e.g. providers, community health workers) and Spanish-speaking patients with LEP. For both aims, we will consider how the multi-faceted contributions of social determinants of health relate to the delivery of high-quality, equitable telemedicine-based services to LEP patients. The results will be utilized to inform an evidence- based toolkit of best practices for equitable telemedicine delivery for patients with LEP in an outpatient setting to be evaluated in future studies.