Disparities in the Era of Telehealth: Evaluating Outcomes and Sociodemographic Factors of Outpatient Palliative Care Telehealth Visits
Virtual visits (patient-clinician video or telephone visits in real-time) have increased rapidly over the past decade in outpatient palliative care. The COVID-19 pandemic and changes to reimbursement policies have propelled their growth and reinforced virtual visits as a new norm in care delivery. Yet, data are lacking on the association between virtual visits and palliative care outcomes, and on virtual visit feasibility for palliative care, particularly among populations experiencing systemic patterns of disadvantage, such as persons of color and those with limited English proficiency (hereafter referred to as underserved populations). Underserved populations experience lower quality and utilization of palliative care. They also face significant barriers to virtual visits, raising concerns that the increasing use of virtual visits may widen existing disparities in palliative care. However, this remains unknown. The objective of this proposal is to evaluate a full range of palliative care outcomes among in-person versus virtual outpatient palliative care clinic visits and examine facilitators of and barriers to virtual outpatient palliative care among underserved populations. This proposal investigates two specific aims: 1) evaluate differences in outpatient palliative care process outcomes (screening for psychosocial, spiritual, goals of care needs) and clinical outcomes (e.g., change in pain over time) by visit type (in-person vs virtual) and assess disparities by race/ethnicity and preferred language using national Palliative Care Quality Network data (N>12,000 patients), and 2) examine facilitators of and barriers to virtual outpatient palliative care, particularly among underserved populations, through in-depth interviews and focus groups. This work will have significant impact in assessing the use, outcomes, and feasibility of virtual outpatient palliative care. It will also lay the groundwork for my research program focused on developing interventions to increase access to equitable, high quality palliative care for underserved populations with serious illness including with virtual visits and other digital health tools.
MD, MPH is an Assistant Professor of Medicine in the Division of Palliative
Medicine at the University of California San Francisco (UCSF). She received her
BA in Anthropology and BS in Ecology at Rice University, her MD at the
University of Texas Southwestern Medical School, and her MPH at the Harvard
School of Public Health. She went on to complete her Internal Medicine
residency at Duke University in the Ambulatory Care Leadership Track, followed
by a Primary Care Research Fellowship then a Hospice and Palliative Medicine
fellowship at UCSF. She serves on the Steering Committee for the San Francisco
Palliative Care Workgroup. Dr. Nouri’s research focuses on achieving equity in
serious illness communication and palliative care access, utilization, and
quality among populations experiencing systemic disadvantage and racism.