Center of Excellence in Precision Medicine and Population Health

The COVID-19 pandemic is not affecting everyone equally. In Nashville, Tennessee, the number of confirmedCOVID-19 cases are higher in ZIP Code regions that are burdened by poorer social determinants of health andhigher rates of conditions such as asthma. To allow for safe, effective, and physically distant care,telemedicine has emerged as a modality for preferred health care delivery. However, telemedicine requiresaccess to technology, broadband internet access, technologic literacy, and in many cases, English proficiency.These are often inaccessible to vulnerable populations who, additionally, may have privacy concerns and beless trusting of telemedicine. Now that the Health and Human Services (HHS) guidelines for telemedicine arerelaxed, creating greater ease for lower income diverse populations to access this modality from their home, itmust be built to ensure access equity that allows for a more precise tailored approach. Despite indications thatchildren are less often infected with COVID-19 than adults, utilization of overall child health care hasdecreased substantially since the pandemic gained traction with physical distancing requirements, but the useof telemedicine in children has not increased. This is especially true if those children are from underrepresented minority populations. We propose an administrative supplement to understand what makestelemedicine feasible and acceptable in underserved populations. In Aim 1, we will randomly select VanderbiltPediatric Primary Care patients who live in ZIP Code regions reflective of racially and ethnic diverse patientfamilies with higher social needs (N=500) and measure retrospective telemedicine utilization during the earlyperiod of the COVID-19 pandemic (from March 1- June 30, 2020). We will conduct a 30-60 minute telephonicsurvey in the participant language of choice (English, Spanish, or Arabic) to assess telemedicine utilization,knowledge, interest, accounting for social determinants of health, COVID-19 impact, technology access,race/ethnicity, and patient trust. We will then use the knowledge gained to prospectively design and testmodified telemedicine approaches, assessing the feasibility and acceptability of telemedicine visits provided to100 low-income pediatric patients (50 English and 50 non-English). Process data collected will include selectedtelemedicine platform (of the HHS accepted choices), visit length, and patient-family and provider satisfaction.Qualitative data collected will identify both patient-family and provider barriers and facilitators. These data willinform policies and processes to create equitable telehealth approaches for diverse pediatric populations.