Study: Racial / Ethnic and Linguistic Inequalities in How Patients Get COVID-19 Test

The COVID-19 pandemic has caused an unprecedented disruption in healthcare delivery, with resources reallocated to telehealth services and mass viral testing. While early studies of the pandemic highlighted differences in healthcare use among commercially insured patients, data on insured and uninsured “safety net” patient populations continue to grow. ’emerge.

A recent study by researchers at the University of Minnesota and the Hennepin Healthcare Research Institute (HHRI) is among the first to examine how different socio-demographic groups have used telehealth, ambulatory care (i.e. clinics), emergency departments and inpatient care (i.e. hospitals). to test for SARS-CoV-2, the virus that causes COVID-19. Their findings were recently published in JAMA network open.

The study was led by the U of M School of Public Health graduate student Rohan Khazanchi. Along with others from Hennepin Healthcare and HHRI, the researchers included Medicine School Assistant professor Tyler winkelman, which is also with the U of M Robina Institute of Criminal Law and Criminal Justice, and HHRI Data Scientist Peter Bodurtha. The team analyzed anonymous data from electronic health records for people with symptoms of viral illness who were tested for SARS-CoV-2 at Hennepin Healthcare, a large safety net health system in Minneapolis. .

The study found that:

• Patients who started the test via telehealth were disproportionately white and English speaking, while patients who started the test through the emergency department were disproportionately black, Native American, non-English speaking, and had one or more pre-existing conditions.
• Tests initiated via telehealth and outpatient visits were associated with lower rates of inpatient and subsequent intensive care than tests initiated in more care-demanding settings, such as emergency departments.

“Inequalities by race, ethnicity and language in where people seek tests for SARS-CoV-2 may point to several structural causes, including barriers to accessing timely testing,” delays in seeking care, difficulties in accessing telehealth services and higher rates of pre-existing. in patients who require higher levels of care, ”Khazanchi said.

The researchers also added that the inequalities could be explained in part by variations of clinicians and clinics in the use of telehealth.

“Without structural reforms, the rapid implementation of telehealth and other new services can exacerbate inequalities in access to care, especially if these investments are made at the expense of other sites of care,” Bodurtha said.

The authors said that as investigators explore the effects of the COVID-19 pandemic on healthcare use and patient outcomes, future research should continue to examine how and why healthcare use of health by patients benefiting from a safety net differs from that of commercially insured individuals in order to inform about fairness. interventions.

The study was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences (# UL1TR002494).

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