COVID-19 and Health Disparities Pilot Projects
In partnership with the Center of Excellence in Diversity in Medical Education, the Office of Faculty Development and Diversity awarded six pilot grants to Stanford University School of Medicine faculty in response to the COVID-19 outbreak. These grants are intended to support the advancement of research into the impact of COVID-19 on the wellbeing, health service use, and health outcomes of populations that experience health disparities in the United States.
Are Sociodemographic and Economic Disparities Associated with the Impact of the COVID-19 Crisis on Parents, Families, and Children Born Extremely Preterm in California?
The aim of this project is to answer questions related to the broad and growing impact of the COVID-19 pandemic on children born preterm, their parents, and families, and to explore associations of post-discharge child healthcare access challenges, adverse child health effects, and parent stress and anxiety with sociodemographic disparities, and with NICU and HRIF clinic factors. To meet these objectives, we will launch a multilevel, serial survey to determine how parents and families of children born < 30 weeks estimated gestational age in California are impacted by the COVID-19 pandemic crisis - including parental stress and anxiety, access to medical and special health care services, financial and resource stability - through 3 years of age. For this project, we will focus on a 6-month birth cohort of children and families who were in a CPQCC NICU during the COVID-19 pandemic and referred CPQCC CCS HRIF at discharge, with surveys at 4-8 months of age and 12-16 months of age corrected for prematurity.
Demographic Biases in COVID-19 in the Medicaid Population
First thought to be the big equalizer, a mounting body of evidence suggests that COVID-19 further exacerbates health disparities among ethnic groups. The disproportionate impact of this pandemic on minorities in terms of infection rate, hospitalizations and mortality is striking. Here, we have a unique opportunity to leverage an existing data agreement with 10 diverse states to use state-level Medicaid data to assess and predict COVID-19 outcomes across diverse racial and ethnic populations. We will use basic descriptive statistics to report rates of COVID outcomes across populations and develop predictive algorithms to understand features associated with disease manifestation. Our goal is to better understand drivers of disparate rates, of resource allocation, and of testing opportunities. This work will fill a gap in our knowledge on the impact of COVID-19 across diverse populations and provide evidence to state stakeholders to guide policy and resource allocation.
Strengthening School Nutrition Programs to Address Food Insecurity for Latinx Immigrant Populations during COVID-19 and Beyond
This study focuses on four rural school districts in Kern and Fresno counties in the San Joaquin Valley region that are home to Latinx immigrant farm-working families. Despite being the top agricultural region in the nation, the area has the highest rates of food insecurity in California. Through semi-structured interviews with school district officials and community-based organizations, and focus groups with parents/caregivers of students in the school districts, we will gather rich 360° perspectives regarding the strengths and weaknesses of school meal programs in serving rural immigrant Latinx families during COVID-19. Findings will inform a local campaign to help schools combat food insecurity. Lessons learned will also be used to create policy and practice recommendations for strengthening school meal programs to best serve the needs of immigrant Latinx families and rural populations.
Improving Outreach to and Telehealth Access for Spanish-Speaking Community Members who Have Tested Positive for COVID-19 at the Roots Community Health Center
The coronavirus is a public health crisis impacting every facet of society with available data suggesting that it may be particularly devastating to African American and Latinx communities, bringing overdue attention to already well documented broader health disparities faced by these communities. In parallel to the pandemic magnifying existing health disparities, we have seen a tectonic shift in health care delivery to telehealth – telephonic, video, patient portal, text messaging, asynchronous communication, and remote monitoring modalities. We know that the current wide-spread implementation may further exacerbate existing health disparities by providing inequitable access to historically vulnerable populations. Community-responsive telehealth programs are critical to ensure gaps in health access are closed and not widened.
The two aims of this project are to (1) increase outreach to Spanish-speaking patients who have tested positive for COVID-19 and connect them with the health system for follow-up care and essential services, and (2) create a sustainable, community-responsive telehealth program that is developed based on the expressed needs and capabilities of this same patient population.
Zooming Out: Disparities in Pediatric Telehealth Utilization Associated with COVID-19
The aim of this project is to evaluate the uptake of telehealth and its impact on healthcare utilization; analyze the impact of sociodemographic factors on telehealth adoption; and explore how this varies by pediatric subspecialties/disease types.
Healthcare systems have rapidly adopted telehealth modalities to maintain routine patient care in response to COVID-19 and precautions on in-person interaction. Previous research has illustrated adult and pediatric patients of vulnerable sociodemographic groups such as race, ethnicity, and income level—as well as those with medical complexity—face disproportionate barriers to uptake of telehealth. The culmination of these factors implies that, even as new virtual technologies may improve the overall outcomes in some pediatric populations, they may serve to exacerbate outcome disparities for minority populations.
Lillie Reed, Bianca Mulaney, Victoria Yuan, Sierra Kaitlyn Ha, Vardhaan Sai Ambati, Maria Valentina Suarez-Nieto
Cardinal Free Clinics’ Telehealth Initiative to Address Health Disparities and Social Needs in the South Bay During the COVID-19 Pandemic
The Cardinal Free Clinics are Stanford Medicine’s two student-run free clinics serving uninsured and underinsured individuals in the South Bay Area. Due to the ongoing COVID-19 crisis, the clinics are operating in a telehealth format. Through patient interviews, community partner interviews, and analysis of electronic medical record data, a team of faculty and students seeks to understand (1) how the pandemic has affected the clinics’ patients’ access to health and social care, including COVID-19 care, (2) how the patients’ social needs have changed from March 2020 to the present, and (3) how the pandemic has affected the community organizations that provide social and health support to the patients. In addition to providing more information on health disparities in South Bay Area communities, this project will be used to improve the social needs screening conducted in telehealth visits, enhance referral offerings and help the clinics be better community partners to other South Bay organizations.