DOI: 10.5061/dryad.c866t1g79
title: OHSU 2019-2020 utilization of ambulatory telehealth and office visits by patient demographics

description: The COVID-19 pandemic and subsequent expansion of telehealth may be
 exacerbating inequities in ambulatory care access due to institutional and
 structural barriers. We conduct a repeat cross-sectional analysis of
 ambulatory patients to evaluate for demographic disparities in the
 utilization of telehealth modalities. The ambulatory patient
 population at Oregon Health & Science University (Portland, OR) is
 examined from June 1 through September 30, in 2019 (reference period) and
 in 2020 (study period). We first assess for changes in demographic
 representation and then evaluate for disparities in the utilization of
 telephone and video care modalities using logistic regression. Between the
 2019 and 2020 periods, patient video utilization increased from 0.2% to
 31%, and telephone use increased from 2.5% to 25%. There was also a small
 but significant decline in the representation males, Asians, Medicaid,
 Medicare, and non-English speaking patients. Amongst telehealth users,
 adjusted odds of video participation were significantly lower for those
 who were Black, American Indian, male, prefer a non-English language, have
 Medicaid or Medicare, or older. A large portion of ambulatory patients
 shifted to telehealth modalities during the pandemic. Seniors, non-English
 speakers, and Black patients were more reliant on telephone than video for
 care. The differences in telehealth adoption by vulnerable populations
 demonstrate the tendency towards disparities that can occur in the
 expansion of telehealth and suggest structural biases. Organizations
 should actively monitor the utilization of telehealth modalities and
 develop best-practice guidelines in order to mitigate the exacerbation of
 inequities.
description: A repeat cross-sectional study was conducted of patients who
 utilized the ambulatory clinics at Oregon Health & Science
 University (OHSU) from June 1 through September 30, in 2019 (reference
 period) and 2020 (study period). The study period was chosen because it
 exhibited a relatively stable rate of in-person, telephone, and video
 ambulatory visits. The initial months of the pandemic in March through May
 2020 were marked by shifting state and institutional policies that
 affected appointment availability. By the summer of 2020, clinics were
 more open to scheduling in-person visits. We chose to investigate a later,
 more stable time-frame for disparities because we believe that the
 analysis would be more indicative of ongoing trends.
 Unique patient counts were extracted from ambulatory provider-led
 visits, defined as outpatient visits with physicians, nurse practitioners,
 or physician assistants. Visits modalities included in-person, video, or
 telephone, the latter two comprising telehealth. Patient demographics
 included ethnicity, race, preferred language, payer, age, and sex. The
 encounter-level data was aggregated by unique patient identifier into
 patient counts for the study period of June 1 through Sept 30, 2020. Table
 1 displays unique patient counts of ambulatory care modality utilization
 (in-person, video, telephone, and any telehealth) for each demographic
 group (race, ethnicity, sex, preferred language, insurance, and age).
 There is also a column for total patients in that demographic group. In
 the main article, we performed logistic regression to evaluate the
 association of patient demographics with telehealth utilization. Table
 2 displays unique patient counts of ambulatory care modality utilization
 for each demographic group only within primary care clinics.
 Table 3 displays unique patient counts for each demographic
 group within the time periods before and during the COVID-19 pandemic:
 June 1 through Sept 30, 2019 and June 1 through Sept 30, 2020. In the
 study, we compared the proportional representation of demographic groups
 between before and during the pandemic to assess for overall changes in
 our patient population.
description: The original patient-level and encounter-level data underlying
 the analysis would identify individuals and cannot be shared for privacy
 reasons. Aggregate data have been shared here.<br> Table
 1: table1_uniquepatients_modality_x_demographic.csv
 Table 2: table2_uniquepts_modal_x_demo_primaryonly.csv
 Table 3: table3_uniquepts_prepostpandemic_x_demo.csv
 ReadMe: OHSU_2019_2020_utilization_ambulatory_telehealth.txt