Document text
Principal Investigator: Peiyin Hung
Organization: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
Fiscal Year: 2024
Award: $603,549
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Project Summary
The Coronavirus disease 2019 (COVID-19) pandemic has caused significant social, healthcare, and economic
devastation in the United States (US), potentially exacerbating the maternal health disparities facing rural
women and women of color. Telehealth represents a promising opportunity to reducing disparities in maternal
health access, quality, and outcomes, given its substantial range of opportunities, including audiovisual
synchronous and asynchronous encounters between patients and providers, remote patient monitoring,
facilitating visual communication of evidence-based practice, and supporting clinical decision-making. Yet,
multilevel barriers might hinder some underserved women from fully benefiting from telehealth. Expanded
federal and state-level telehealth coverage through the Coronavirus Aid, Relief, and Economic Security
(CARES) Act and state policies may be mitigating the detrimental effects of this unprecedented pandemic by
reducing gaps in access to telehealth and quality maternity care. Although self-reported data indicated abrupt
increases in telehealth uptake during the pandemic, limited real-world data are available regarding the role of
perinatal telehealth uptake on the pandemic’s effects and the role of state level policy in telehealth adaptation
during COVID-19. This longitudinal, real-world data study will use recurring national electronic health records
(EHR) data [National COVID Cohort Collaborative (N3C)] and integrated statewide population-based data in
South Carolina and Florida which complement the overrepresentation of urban populations in N3C. With
multiple innovative approaches using common data modeling, multi-level imputation for missingness, and
Bayesian statistics simulation methods, this study aims to: 1) investigate the impact of the COVID-19 pandemic
on maternal care access, quality, and maternal and birth outcomes by maternal race/ethnicity and rural/urban
residence; 2) examine whether perinatal telehealth uptake mitigates the pandemic's effects on disparities in
maternal care access, quality, and outcomes by maternal race/ethnicity and rural/urban residence; and 3)
assess how state-level telehealth policies (relaxation for originating sites, reimbursements for store-and-
forward services, remote patient monitoring, and provider expansion) – relate to perinatal telehealth uptake by
race-ethnicity and rural/urban residence. We will also 4) develop a stochastic simulation model to predict
long-term changes in maternal care access, quality, outcomes, and expenditures of maternity care, with and
without each respective state telehealth policy. Our overarching goal is to advance the understanding of the
three-way intersections among the COVID-19 pandemic, state telehealth policy, and perinatal telehealth uptake
on health disparities facing vulnerable maternal populations – rural and racial/ethnic minority women. We
have formed a multidisciplinary team of investigators, including 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 to conduct this study.
Terms: <Acceleration><Access to Care><Adopted><Advocate><American><Bayesian Analysis><Bayesian computation><Bayesian inference><Bayesian network analysis><Bayesian spatial analysis><Bayesian statistical analysis><Bayesian statistical inference><Bayesian statistics><Big Data><BigData><Birth><Black Populations><Black group><Black individual><Black people><Blacks><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 crisis><COVID-19 effect><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 impact><COVID-19 impacted><COVID-19 infection><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 predisposition><COVID-19 public health crisis><COVID-19 susceptibility><COVID-19 virus infection><COVID-19 vulnerability><COVID-19 years><COVID19 infection><CV-19><Caring><Clinical><Communication><Community Surveys><Complement><Complement Proteins><Coronaviridae><Coronavirus><Coronavirus Infectious Disease 2019><Coronavirus disease 2019 predisposition><Coronavirus disease 2019 susceptibility><Coronavirus disease 2019 vulnerability><Cost Savings><Costs and Benefits><Data><Data Bases><Data Reporting><Databases><Death Certificates><Death Rate><Decrease disparity><Development><Discipline of obstetrics><Disparities><Disparity><E-Mail><Economic Income><Economical Income><Economics><Electronic Health Record><Electronic Mail><Email><Epidemiologist><Equity><Ethnic Minority Women><Ethnic Origin><Ethnicity><Evidence based practice><Expenditure><Fear><Financial Hardship><Florida><Fright><Future><Geography><Goals><Health><Health Care Systems><Health Expenditures><Health Insurance><Health Policy><Health Services><Health Services Accessibility><Healthcare><Healthcare Systems><Hispanic Females><Hispanic Populations><Hispanic Women><Hispanic group><Hispanic individual><Hispanic people><Hispanics><Hospital Admission><Hospitalization><Hybrids><Income><Infant Health><Internet><Interruption><Investigators><Legislation><Location><Lower disparity><Machine Learning><Maternal Health><Maternal Health Services><Measures><Medicaid><Methods><Minority><Minority Female><Minority Women><Obstetrics><Outcome><Parturition><Patient Self-Report><Patients><Perinatal><Peripartum><Persons><Policies><Population><Predisposed to COVID-19><Predisposed to SARS-CoV-2><Predisposed to Severe acute respiratory syndrome coronavirus 2><Pregnant Women><Provider><Psychologist><Psychosocial Stress><QOC><Quality of Care><Race><Races><Recurrence><Recurrent><Regulation><Relaxation><Research><Research Personnel><Research Resources><Researchers><Resources><Role><Rural><Rural Community><Rural Health><Rural Hospitals><Rural Minority><Rural Population><Rural group><Rural people><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global 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