Telehealth Post-Stroke Utilization by Gender

Project Overview

Workplan Goal: This is the second phase of a 2-phase project that focuses on measuring the impact of telehealth in potentially narrowing post-stroke care gender-based disparities. In this second phase, we will complete the main analyses of (1) differences in telehealth uptake among stroke patients following payment parity reform, (2) differences in telehealth uptake among stroke patients following coverage parity reform, (3) differences in telehealth uptake, by gender, following either reforms, and (4) differences in telehealth uptake levels, by gender, and the extent to which these differences are associated with different rates of secondary strokes.

Rationale: Women are on average more likely than men to have worse health outcomes following a stroke. Part of this has to do with differences in presenting symptoms in which women on average have more headaches, more changes in consciousness and mental state, a higher likelihood of falling into a coma or presenting with stupor, and more instances of dysarthria and vertigo [1]. At the same time, there is generally a high no-show rate for post-stroke follow-up care [2], which itself will have an adverse impact on clinical management and contribute to the poorer outcomes. Finally, there is evidence (from others and my own research) that suggests that women are more likely to utilize telehealth [3], which has increasingly been used in post-stroke care management. Taken together, there is a promising opportunity to evaluate the extent to which telemedicine may narrow these clinical gaps and improve equitable post-stroke care outcomes.

References:
1 Ali, Mariam, Hendrikus JA van Os, Nelleke van der Weerd, Jan W. Schoones, Martijn W. Heymans, Nyika D. Kruyt, Marieke C. Visser, and Marieke JH Wermer. "Sex differences in presentation of stroke: a systematic review and meta-analysis." Stroke 53, no. 2 (2022): 345-354.
2 Elkhider, Hisham, Rohan Sharma, Sen Sheng, Jeff Thostenson, Nidhi Kapoor, Poornachand Veerapaneni, Suman Siddamreddy et al. "Predictors of no-show in neurology clinics." In Healthcare, vol. 10, no. 4, p. 599. MDPI, 2022.
3 Walker, Brigham, Charles Stoecker, Yixue Shao, Elizabeth Nauman, Edmond K. Kabagambe, and Lizheng Shi. "Predictors of telehealth utilization and subsequent inpatient stays and emergency visits during the COVID-19 pandemic among patients with type 2 diabetes: evidence from Louisiana." Telemedicine and e-Health (2023).