PDF(Pubmed)
Abstract：
BACKGROUND: During the first nine months of the COVID-19 emergency, patients were encouraged to use virtual versus clinic visits if in-person care was not deemed necessary by clinical staff. This study examined the association of spoken language preference and ethnicity with use of video versus phone virtual visits by US Latino and Chinese adult patients who got care in the same healthcare system.
METHODS: We analyzed electronic health record data for four groups of adults aged 26-85y who had ≥ 1 primary or specialty care outpatient clinician visits during April-December 2020: 80,869 Latino adults preferring Spanish (LEP Latino); 214,765 Latino adults preferring English (non-LEP Latino); 23,430 Chinese adults preferring a Chinese dialect (LEP Chinese); and 49,710 Chinese adults preferring English (non-LEP Chinese). Prevalence of the following utilization outcomes were compared by language preference (LEP/non-LEP) within ethnicity and by ethnicity within language preference for four age subgroups (26-39y, 40-64y, 65-75y, and 76-85y): ≥ 1 virtual (video or phone) visit, ≥ 1 video visit, ≥ 1 phone visit, ≥ 1 clinic visit, video visits only, and phone visits only. We also compared ethnicity x language group differences within age subgroups using absolute difference and adjusted prevalence ratios derived from modified log-Poisson regression models that controlled for age and sex.
RESULTS: Among virtual users, LEP Latino and Chinese adults were significantly less likely to use video visits and more likely to use phone visits than non-LEP Latino and Chinese adults in the same age strata. The LEP/non-LEP difference in video visit use was significantly larger among Latino than Chinese patients, with no similar ethnic group difference observed for phone visits. Within the LEP and non-LEP language groups, Chinese adults were significantly more likely than Latino adults to use video visits and less likely to use phone visits.
CONCLUSIONS: During the first nine months of the COVID-19 pandemic, uptake of video and phone virtual visits by Latino and Chinese adults significantly differed by LEP/non-LEP status within ethnicity and by ethnicity within LEP/non-LEP language group. These findings underscore the importance of disaggregating data by ethnicity and language preference when attempting to understand and study patient use of different virtual visit modalities.
METHODS: We analyzed electronic health record data for four groups of adults aged 26-85y who had ≥ 1 primary or specialty care outpatient clinician visits during April-December 2020: 80,869 Latino adults preferring Spanish (LEP Latino); 214,765 Latino adults preferring English (non-LEP Latino); 23,430 Chinese adults preferring a Chinese dialect (LEP Chinese); and 49,710 Chinese adults preferring English (non-LEP Chinese). Prevalence of the following utilization outcomes were compared by language preference (LEP/non-LEP) within ethnicity and by ethnicity within language preference for four age subgroups (26-39y, 40-64y, 65-75y, and 76-85y): ≥ 1 virtual (video or phone) visit, ≥ 1 video visit, ≥ 1 phone visit, ≥ 1 clinic visit, video visits only, and phone visits only. We also compared ethnicity x language group differences within age subgroups using absolute difference and adjusted prevalence ratios derived from modified log-Poisson regression models that controlled for age and sex.
RESULTS: Among virtual users, LEP Latino and Chinese adults were significantly less likely to use video visits and more likely to use phone visits than non-LEP Latino and Chinese adults in the same age strata. The LEP/non-LEP difference in video visit use was significantly larger among Latino than Chinese patients, with no similar ethnic group difference observed for phone visits. Within the LEP and non-LEP language groups, Chinese adults were significantly more likely than Latino adults to use video visits and less likely to use phone visits.
CONCLUSIONS: During the first nine months of the COVID-19 pandemic, uptake of video and phone virtual visits by Latino and Chinese adults significantly differed by LEP/non-LEP status within ethnicity and by ethnicity within LEP/non-LEP language group. These findings underscore the importance of disaggregating data by ethnicity and language preference when attempting to understand and study patient use of different virtual visit modalities.
摘要：
背景：在COVID-19紧急情况的前9个月，如果临床工作人员认为没有必要进行当面护理,我们鼓励患者使用虚拟访视与临床访视.这项研究调查了在同一医疗保健系统中获得护理的美国拉丁裔和中国成年患者使用视频与电话虚拟访问的口语偏好和种族之间的关系。
方法：我们分析了四组26-85岁成年人的电子健康记录数据，这些成年人在2020年4月至12月期间有≥1次初级或专科护理门诊临床医师就诊：80,869名拉丁裔成年人更喜欢西班牙语（LEPLatino）；214,765名拉丁裔成年人更喜欢英语（非LEPLatino）；23,430名中国成年人更喜欢汉语通过种族内的语言偏好（LEP/非LEP）和四个年龄亚组的语言偏好内的种族（26-39岁，40-64y,65-75y,和76-85y)：≥1次虚拟(视频或电话)访问，≥1次视频访问,≥1次电话访问,≥1次临床就诊，仅限视频访问，只有电话访问。我们还使用绝对差异和从控制年龄和性别的改良log-Poisson回归模型得出的调整后的患病率比，比较了年龄亚组中的种族x语言组差异。
结果：在虚拟用户中，LEP拉丁裔和中国成年人使用视频访问的可能性明显低于同一年龄段的非LEP拉丁裔和中国成年人使用电话访问的可能性。LEP/非LEP在视频访问使用方面的差异在拉丁裔患者中明显大于中国患者，在电话访问中没有观察到类似的种族差异。在LEP和非LEP语言组中，中国成年人比拉丁裔成年人更有可能使用视频访问，而不太可能使用电话访问。
结论：在COVID-19大流行的前9个月，拉丁美洲人和中国成年人对视频和电话虚拟访问的吸收在种族中的LEP/非LEP地位以及LEP/非LEP语言组中的种族之间存在显着差异。这些发现强调了在尝试理解和研究患者对不同虚拟访问方式的使用时，按种族和语言偏好分类数据的重要性。
方法：我们分析了四组26-85岁成年人的电子健康记录数据，这些成年人在2020年4月至12月期间有≥1次初级或专科护理门诊临床医师就诊：80,869名拉丁裔成年人更喜欢西班牙语（LEPLatino）；214,765名拉丁裔成年人更喜欢英语（非LEPLatino）；23,430名中国成年人更喜欢汉语通过种族内的语言偏好（LEP/非LEP）和四个年龄亚组的语言偏好内的种族（26-39岁，40-64y,65-75y,和76-85y)：≥1次虚拟(视频或电话)访问，≥1次视频访问,≥1次电话访问,≥1次临床就诊，仅限视频访问，只有电话访问。我们还使用绝对差异和从控制年龄和性别的改良log-Poisson回归模型得出的调整后的患病率比，比较了年龄亚组中的种族x语言组差异。
结果：在虚拟用户中，LEP拉丁裔和中国成年人使用视频访问的可能性明显低于同一年龄段的非LEP拉丁裔和中国成年人使用电话访问的可能性。LEP/非LEP在视频访问使用方面的差异在拉丁裔患者中明显大于中国患者，在电话访问中没有观察到类似的种族差异。在LEP和非LEP语言组中，中国成年人比拉丁裔成年人更有可能使用视频访问，而不太可能使用电话访问。
结论：在COVID-19大流行的前9个月，拉丁美洲人和中国成年人对视频和电话虚拟访问的吸收在种族中的LEP/非LEP地位以及LEP/非LEP语言组中的种族之间存在显着差异。这些发现强调了在尝试理解和研究患者对不同虚拟访问方式的使用时，按种族和语言偏好分类数据的重要性。
