The Mitigating Effects of Telehealth Uptake on Disparities in Maternal Care Access, Quality, Outcomes, and Expenditures, United States, 2018-2022

This study explores whether perinatal telehealth uptake has mitigated the pandemic's effects on disparities in maternal care access, quality, and outcomes by race, ethnicity, and rural or urban residence. Research to date has approached this question in several ways. First, researchers have utilized census data to assess whether community-wide broadband infrastructure exists to support the use of telehealth services in areas with high travel times to maternal care units. Findings suggest that socioeconomically disadvantaged communities face significant barriers to maternity care access, both with substantial travel burdens and inadequate digital access to facilitate telehealth services. Second, to examine maternal care quality, researchers have employed South Carolina hospital-based claims data and vital statistics to identify racial, ethnic, and urban/rural disparities in rates of cesarean delivery before and during the COVID-19 pandemic period. Results indicate that cesarean rates differed by rural vs. urban facility locations and racial and ethnic groups but observed disparities were not significantly exacerbated by the pandemic. Third, using South Carolina hospital-based claims data and COVID-19 testing data, researchers found significant racial, ethnic, and rural disparities in postpartum readmissions involving mental health and substance use disorders from childbirth discharge through one year postpartum during the COVID-19 pandemic. Finally, drawing on data from the National COVID Cohort Collaborative (N3C), research has shown that hybrid care increased substantially during the COVID-19 public health emergency, but pregnant people living in rural areas had lower levels of hybrid care than urban people, and individuals who belonged to racial and ethnic minority groups were more likely to have hybrid care than White individuals.

Future research will investigate the impact of the COVID-19 pandemic and perinatal telehealth uptake on additional maternity care and birth outcomes by race, ethnicity, and urbanicity. The study also aims to assess how state-level telehealth policies relate to perinatal telehealth uptake by race, ethnicity, and urbanicity, and to develop a model to predict long-term changes in maternal care access, quality, outcomes, and expenditures, with and without state telehealth policies.

The ICPSR provides variable-level metadata for the data associated with this study. The actual data may only be available from the Principal Investigator directly. The variable descriptions available through ICPSR also include information regarding the source of each variable listed, as does the Data Source field of these metadata.