IMPORTANCE As telemedicine use expands, it is important to evaluate demographic and socioeconomic disparities among patients receiving ophthalmic care through new hybrid telemedicine models. OBJECTIVE To evaluate whether there are demographic and socioeconomic disparities in the delivery of the hybrid telemedicine model. DESIGN Retrospective, cross-sectional, case-control analysis of patient encounters from April to December 2020. SETTING A single, academic, hospital-based eye clinic in Boston, Massachusetts. METHODS Electronic medical records of all patient encounters from April to December 2020 were reviewed and categorized into hybrid, virtual-only, and standard in-person visits. Patient-level data for all visits were extracted including age, sex, race/ethnicity, primary language, Area Deprivation Index (ADI), insurance type, and marital status. Visit-level data for all hybrid visits were also extracted from the medical record including the visit dates and patient adherence. Demographics for the cohort of patients with at least one no-show visit were compared with demographics for the cohort of patients who only had completed visits. The primary study outcomes were the differences in demographic characteristics between the hybrid visit show and no-show groups. The secondary outcomes included demographic characteristics of patients who did not complete their hybrid visit versus a time-matched cohort of patients who did not complete their standard in-person visit. Continuous variables for patient characteristics were compared with independent samples t-tests and categorical variables were compared using Pearson chi-square tests. Multivariate logistic regression was used to examine the differences between the cohorts. Variables with missing values other than suppressed ADI values were imputed using multiple imputations by chained equations. RESULTS Of a total of 1025 patients who were scheduled for a hybrid visit, 145 (14.1%) patients failed to complete their visit. Primary language and insurance were found to be statistically different between patients who completed and did not complete their hybrid visits. More English speakers and fewer Haitian Creole speakers completed their hybrid visits (p = 0.007) while more patients with private insurance and fewer patients with Medicaid completed their hybrid telemedicine visits (p = 0.026). No associations were found between hybrid telemedicine visit adherence and age, sex, race/ethnicity, marital status, or ADI. When the 145 patients who failed to complete their hybrid visits were compared to a time-matched cohort of patients who failed to complete their standard in-person visit, we found that patients who missed hybrid visits were similar to those who missed standard in-person visits except for patients insured by Medicare. These patients were more likely to miss a hybrid visit than a standard in-person visit (Odds Ratio 2.199, 95% confidence interval 1.136-4.259, p = 0.019). No associations were found between patient nonadherence with hybrid telemedicine versus with standard in-person visits based on age, sex, primary language, race/ethnicity, marital status, or ADI. CONCLUSION The hybrid telemedicine model was associated with insurance and language-based disparities. Patients with non-English primary language and Medicaid recipients were more likely to miss a hybrid visit than their counterparts. Our findings support developing deliberate interventions to ensure hybrid telemedicine care is delivered equitably to all patients.

中文翻译：

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混合眼科远程医疗模式中的人口和社会经济差异。

重要性随着远程医疗使用的扩大，通过新的混合远程医疗模型评估接受眼科护理的患者之间的人口和社会经济差异非常重要。目的 评估混合远程医疗模式的实施是否存在人口和社会经济差异。设计对 2020 年 4 月至 12 月患者就诊情况进行回顾性、横断面、病例对照分析。设置位于马萨诸塞州波士顿的一家单一、学术、医院眼科诊所。方法 对 2020 年 4 月至 12 月所有患者就诊的电子病历进行审查，并将其分为混合式就诊、纯虚拟就诊和标准面对面就诊。提取所有就诊的患者级别数据，包括年龄、性别、种族/民族、主要语言、地区剥夺指数 (ADI)、保险类型和婚姻状况。所有混合就诊的就诊级别数据也从医疗记录中提取，包括就诊日期和患者依从性。将至少一次未出现就诊的患者队列的人口统计数据与仅完成就诊的患者队列的人口统计数据进行比较。主要研究结果是混合参观表演组和缺席组之间人口特征的差异。次要结果包括未完成混合就诊的患者与未完成标准亲自就诊的时间匹配患者队列的人口统计特征。将患者特征的连续变量与独立样本 t 检验进行比较，并使用皮尔逊卡方检验对分类变量进行比较。使用多变量逻辑回归来检查队列之间的差异。除了抑制 ADI 值之外，还使用多重插补通过链式方程对具有缺失值的变量进行插补。结果 在计划进行混合就诊的总共 1025 名患者中，有 145 名 (14.1%) 患者未能完成就诊。研究发现，完成和未完成混合就诊的患者的主要语言和保险存在统计学差异。更多说英语的人和更少的说海地克里奥尔语的人完成了混合就诊 (p = 0.007)，而更多拥有私人保险的患者和更少的医疗补助患者完成了混合远程医疗就诊 (p = 0.026)。未发现混合远程医疗就诊依从性与年龄、性别、种族/民族、婚姻状况或 ADI 之间存在关联。当将 145 名未能完成混合就诊的患者与未能完成标准亲自就诊的时间匹配的患者队列进行比较时，我们发现错过混合就诊的患者与错过标准亲自就诊的患者相似除 Medicare 投保患者外的就诊。这些患者比标准面对面就诊更有可能错过混合就诊（优势比 2.199，95% 置信区间 1.136-4.259，p = 0.019）。根据年龄、性别、主要语言、种族/民族、婚姻状况或 ADI，未发现患者不遵守混合远程医疗与标准面对面就诊之间存在关联。结论 混合远程医疗模式与保险和语​​言差异相关。以非英语为主要语言且享受医疗补助的患者比其他患者更有可能错过混合就诊。我们的研究结果支持制定深思熟虑的干预措施，以确保向所有患者公平地提供混合远程医疗护理。