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Study Finds Rural-Urban Disparity in Telehealth Access

Cost, Technological Uncertainty Among Barriers to Changes That Could Benefit Patients and Providers

By Sydney Clark M.Jour. ’21

Telehealth illustration showing doctor coming out of computer screen

Illustration by iStock

Compared to metro area hospitals, rural medical centers were far less likely to offer telehealth systems with patient engagement capabilities like online health information or the ability to electronically transfer medical records, a new UMD study found.

With the COVID-19 pandemic driving health care appointments and services increasingly to virtual formats, a new study by School of Public Health researchers found that hospitals in rural areas faced more barriers than those in urban areas in adopting telehealth approaches. 

In particular, rural hospitals were least likely to offer telehealth systems with patient engagement capabilities, such as viewing health records online or electronically transmitting medical information to a third party. The study, published in the Journal of Rural Health, was co-authored by health policy and management Professor Jie Chen and Ph.D. candidates Aitalohi Amaize and Deanna Barath. Chen directs the Hospital And Public health interdisciPlinarY research (HAPPY) Lab, which studies system-level coordination between hospitals, communities and public health agencies with the aim of reducing health disparities.

Compared to urban areas, rural areas have a higher proportion of older adults, a higher frequency of health disparities, lower patient volume in health care facilities and significantly poorer health care infrastructure, including telehealth adoption and health information technology (HIT) system capabilities.

Telehealth can improve health care delivery and quality while cutting costs. Previous research also suggests that telehealth can expand access to health care both through greater convenience and reduced stress and burnout among frontline health care providers. 

Despite the advantages, the study found that rural hospitals were 6% less likely to adopt any telehealth services compared to metro-area hospitals Among the most dramatic disparities, metro-area hospitals were twice as likely to adopt telehealth for eICU (or remote surveillance of very ill patients in the hospital), stroke care, psychiatric and addiction treatment. Metro hospitals were more than three times as likely as rural ones to adopt telehealth for patient monitoring after discharge. 

The study found that implementation cost was the primary barrier to rural hospitals delving further into telehealth. Additional roadblocks include technological concerns and beliefs that a patient’s needs do not require telehealth services.

Currently, rural areas have rapidly rising COVID-19 case counts and deaths, making this a crucial time to understand barriers to implementing “robust and responsive HIT systems,” the research team said in the study.

The pandemic is not only impacting telehealth now, but it will also transform the landscape of telehealth practice in the long run, according to Chen. 

As more investments go toward forming and strengthening the telehealth capacity in rural areas—including access to broadband networks—the researchers aim to provide important baseline evidence on current hospital telehealth use and barriers. It will be more important than ever to understand the concepts of population health in the post-COVID-19 era, the researchers said. 

Data communication among diverse stakeholders, such as primary care and social services, is critical to promoting care coordination, they said. Ongoing policy initiatives, such as the Accountable Care Organization (ACO) alternative payment model and the ACO Investment Model (AIM), are intended to promote care coordination through financial incentives.

Future research should look at how the public health system can lead or facilitate care coordination efforts across multiple sectors to advance health for rural populations, and examine whether telehealth systems can play a key role by enhancing coordination, the researchers said.

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