Unintended Consequences of Centralized Telehealth Genetic Consultations

Motivation

Future of Healthcare:
Telehealth Increases Access to Genetic Consultations

1. Medical genetics: future of healthcare
-better diagnosis, prognosis, risk assessment, prevention, and targeted treatments.

2. Supply vs demand
-Demand: cancer, gastrointestinal, psychiatry, CVD – the list is growing.
-Supply: insufficient numbers of physicians with training in medical genetics.

3. Solution: telehealth increases access by delivering care across long distances.

Research Questions

Is Increasing Access a Good Thing

Trend: Increasing telehealth consultations

1. 2015-2019: 2X+ genetics consultations.

2. COVID-19 pandemic: telehealth is the predominant mode of care.

3. Can’t get something for nothing – what are the effects of telehealth genetic consultations on quality of care?

Study Scope

Big Data: National Study Spanning 8 Years

Methods and My Role

Research Question:
How is Centralized Telehealth Associated with
Care Coordination and Equity of Genetic Consultation?

My role:
1. Develop & run advanced statistical models

2. Responsible for data integrity & accuracy of analysis

Published Results

-Asian, American Indian/Alaskan Native, and Hawaiian/Pacific Islander patients less likely to get referred for genetic consultations.
-Black patients less likely to complete genetic consultations.

-Completing genetic consultations less likely in community care setting.
-Patients more likely to have multiple preventive procedures if they competed genetic consultation in HCS in-person programs.

Impacts and Lessons Learned

There are efficiencies of scale related to the centralized telehealth genetic consultations, although…

Might compromise quality outcomes such as equity and care coordination.

In the scale-up of centralized telehealth genetic consultations, healthcare system must assess and address structural barriers and the needs and preferences of vulnerable subpopulations.

Such strategies may complement the centralized approach, improve care coordination, and help mitigate healthcare disparities.