Abstract
A mixed-methods observational study investigated telerehabilitation service delivery for patients with limited English proficiency. Findings can inform technology solutions and workflow optimization to improve future practice with this population.
Primary Author and Speaker: Mansha Mirza
Contributing Authors: Courtney Pilat, Jenny Pham
Telehealth increased dramatically after the COVID-19 pandemic. Expansion of telehealth led to better healthcare access with modest expenses. Policy experts recommend telehealth as a viable healthcare option while cautioning about equitable access. Patients with Limited English Proficiency (LEP) are particularly vulnerable to telehealth challenges. We aimed to investigate telerehab delivery for patients with LEP and to identify telerehab barriers and facilitators for this group. Mixed methods, observational study involving secondary analysis of electronic health records (EHRs) from a large academic medical center and semi-structured interviews with a convenience sample of OTs and PTs practicing in the same area. EHRs were retrieved for all outpatient PT/OT visits scheduled between 4/1/2020 and 4/30/2022. Binomial logistic regression models were estimated to examine associations between sociodemographic variables (age, gender, race, ethnicity, insurance status, income, language preference) and visit status (complete vs. incomplete) using Generalized Estimating Equations. Additionally, 6 OTs and 5 PTs completed interviews by Zoom. Thematic analysis was conducted to identify factors that support or hinder telerehab services for patients with LEP. 6.4% of 3871 telerehab visits were conducted in a language other than English. Language of the encounter, age, and type of insurance were found to be significant predictors of visit status. Barriers and facilitators for the successful completion of telerehab appointments were classified under 5 categories: environmental, communication, human, organizational, and technology factors. Being older, being publicly insured, and having LEP was significantly associated with higher odds of incomplete telerehab visits. Practitioners need structural supports to ensure smooth delivery of telerehab for patients with LEP. Findings can inform technology solutions and workflow optimization to improve future practice with this group
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