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Arnold School of Public Health

Does telehealth fail minority, rural pregnant women during the pandemic?

October 5, 2022 | Erin Bluvas,

As scientists assess the adverse effects of the COVID-19 pandemic (both during its height and ongoing), public health concerns continue to emerge. The latest Arnold School project to learn from and address these impacts comes in the form of a $3 million U01 grant to investigate the effects of telehealth on disparities in maternal care during the pandemic. Funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development, the five-year study will be led by health services policy and management (HSPM) assistant professor Peiyin Hung and health promotion, education, and behavior (HPEB) professor Xiaoming Li.

“The COVID-19 pandemic has caused significant social, health care and economic devastation in the United States, potentially exacerbating the maternal health disparities facing rural women and women of color,” says Hung, who serves as deputy director for UofSC’s Rural and Minority Health Research Center. “Telehealth offers a promising opportunity to reducing disparities in maternal health care access, quality and outcomes.”

The researchers point to telehealth’s flexibility and range of services (e.g., options for synchronous/asynchronous audiovisual engagement between patients and providers, remote patient monitoring) as reasons for its potential to improve access to quality maternity care. However, they also note that a variety of barriers might prevent some underserved women, such as women of color and those living in rural communities, from fully benefiting from telehealth.

The Coronavirus Aid, Relief, and Economic Security Act and some state policies expanded telehealth coverage to help solve many of the problems resulting from shutdowns of in-person care and to reduce gaps in access to telehealth and maternity care. Yet despite initial self-reported data indicating a sharp increase in the use of telehealth services, there is a lack of real-world data related to perinatal care delivered via telehealth. Data on the role of state polices on telehealth adaptation is also missing.

By partnering with the UofSC Big Data Health Science Center, which Li co-directs alongside HSPM assistant professor Bankole Olatosi, and the School of Medicine at Cornell University, the multidisciplinary research team* will do what they do best: harness the power of big data. Building on the Center’s Pilot Project Program, this study will leverage large amounts of data from multiple sources, including electronic health records, birth/death certificates, insurance claims, telehealth coverage expansion legislation and nationwide surveys.

Specifically, the researchers are investigating the impact of the COVID-19 pandemic on maternal care access, quality and outcomes by race/ethnicity and rural/urban residence. They will also look at whether telehealth is able to mitigate the effects of disparities in these areas as well as the role played by state-level policies.

“Pregnant women are particularly vulnerable to COVID-19 not only because of increased susceptibility but also because of potential maternal care interruptions caused by widespread mitigation efforts to reduce the spread of the virus. This is especially true for Black and Hispanic women, who have disproportionate COVID-19 infection and death rates, and for women in rural communities, who experience poor maternal outcomes and have unique needs and barriers related to telehealth such as Internet access,” Hung says. “Understanding disparities and factors related to perinatal telehealth use and the pandemic effects on rural minority women is important for developing new policies and initiatives moving forward.”

*This project will be led by Peiyin Hung (Health Services Policy and Management, Principal Investigator), Xiaoming Li (Health Promotion, Education, and Behavior, Co-Principal Investigator), Sayward Harrison (College of Arts and Sciences; Psychology, Co-Investigator), Berry Campbell (School of Medicine, Obstetrics & Gynecology; Co-Investigator), Jihong Liu (Epidemiology and Biostatistics; Co-Investigator), Bo Cai (Epidemiology and Biostatistics; Co-Investigator), Nansi Boghossian (Epidemiology and Biostatistics; Co-Investigator), Chen Liang (Health Services Policy and Management); Co-Investigator) and Jiani Yu (Cornell University; Consultant). The multidisciplinary team includes maternal health services researchers, health policy analysts, telehealth experts, senior clinical researchers, perinatal epidemiologists, rural health advocates, health psychologist, big data analysts and machine learning experts.


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