Novel, High-Impact Studies Evaluating Health System and Healthcare Professional Responsiveness to COVID-19

Project Summary The COVID-19 pandemic necessitated a rapid transition from in-person to telehealth visits to comply with "stay-at-home" and social distancing requirements. No information is currently available about the outcomes associated with the telehealth modalities implemented because of COVID-19. The purpose of the study is to quantify the effects of ceasing in-person outpatient visits, and the resulting increased use of telehealth modalities, among patients with differing social vulnerabilities on the outcomes of: (1) disease control (HbA1c, systolic blood pressure) and (2) health care use (inpatient admissions and emergency department visits). The widespread shift to telehealth visits has created the extraordinary opportunity to understand the differential effects of telehealth visits for those with differing social vulnerabilities using real-world data (linked electronic health record ((EHR) and claims) from over 14M Floridians. The study setting is the OneFlorida Clinical Research Consortium and seven of its health system partners (OneFlorida Partners), who together provide care for over 14M, or 64%, of all Floridians. The patient population and focus of our study are individuals with Type 2 diabetes, hypertension, or both. The OneFlorida Partners serve diverse patient populations in terms of social vulnerability. The study is significant in its quantification of the effects of ceasing all non-emergent in- person visits and transitioning to telehealth modalities on the outcomes of disease control and health care use among those experiencing singular and intersecting social vulnerabilities. The study uses a mixed methods design with interviews and surveys of health system leaders and patients, and leverages the natural experiment that occurred with the rapid transition to telehealth, and for some health systems, the transition back to in-person visits. A novel mathematical generalization of a difference-in-differences (DD) approach will be used to model all post-period measurements simultaneously, while accounting for the covariance of repeated measures, thus increasing power relative to the standard DD approaches. The study aims are to: Aim 1: Quantify the effects of the transition from in-person outpatient visits to the implementation of telehealth and the variations of those effects among those with singular and intersecting social vulnerabilities, on disease control (blood pressure, HbA1c) and health care use (inpatient admissions and emergency department visits). Aim 2. Explore and examine experiences with shared decision-making and care for a subset of patients. Aim 3: Compare the profile of telehealth implementation before and during the COVID-19 pandemic for each OneFlorida clinical partner using in-depth interviews and data reports. Aim 4: Disseminate findings and lessons learned at 6-month intervals throughout the study period using stakeholder engaged, multi-level communication strategies tailored to patients, families, clinicians, health system leaders, third party payers and policymakers.