Project Summary
The COVID-19 pandemic necessitated a rapid transition from in-person to telehealth visits to comply with
“stay-at-home” and social distancing requirements. No information is currently available about the outcomes
associated with the telehealth modalities implemented because of COVID-19. The purpose of the study is to
quantify the effects of ceasing in-person outpatient visits, and the resulting increased use of telehealth
modalities, among patients with differing social vulnerabilities on the outcomes of: (1) disease control (HbA1c,
systolic blood pressure) and (2) health care use (inpatient admissions and emergency department visits). The
widespread shift to telehealth visits has created the extraordinary opportunity to understand the differential
effects of telehealth visits for those with differing social vulnerabilities using real-world data (linked electronic
health record ((EHR) and claims) from over 14M Floridians. The study setting is the OneFlorida Clinical
Research Consortium and seven of its health system partners (OneFlorida Partners), who together provide
care for over 14M, or 64%, of all Floridians. The patient population and focus of our study are individuals with
Type 2 diabetes, hypertension, or both. The OneFlorida Partners serve diverse patient populations in terms of
social vulnerability. The study is significant in its quantification of the effects of ceasing all non-emergent in-
person visits and transitioning to telehealth modalities on the outcomes of disease control and health care use
among those experiencing singular and intersecting social vulnerabilities. The study uses a mixed methods
design with interviews and surveys of health system leaders and patients, and leverages the natural
experiment that occurred with the rapid transition to telehealth, and for some health systems, the transition
back to in-person visits. A novel mathematical generalization of a difference-in-differences (DD) approach will
be used to model all post-period measurements simultaneously, while accounting for the covariance of
repeated measures, thus increasing power relative to the standard DD approaches. The study aims are to:
Aim 1: Quantify the effects of the transition from in-person outpatient visits to the implementation of telehealth
and the variations of those effects among those with singular and intersecting social vulnerabilities, on disease
control (blood pressure, HbA1c) and health care use (inpatient admissions and emergency department visits).
Aim 2. Explore and examine experiences with shared decision-making and care for a subset of patients.
Aim 3: Compare the profile of telehealth implementation before and during the COVID-19 pandemic for each
OneFlorida clinical partner using in-depth interviews and data reports.
Aim 4: Disseminate findings and lessons learned at 6-month intervals throughout the study period using
stakeholder engaged, multi-level communication strategies tailored to patients, families, clinicians, health
system leaders, third party payers and policymakers.
