May 28 Webinar Featuring SBE CCC Pilot Projects

Now in its fifth year, the SBE Consortium Coordinating Center’s pilot project grants address COVID-19’s impact on health disparities and vulnerable populations, foster new collaborations across research teams, and engage new researchers with the work of the consortium. In this session, three pilot project grant recipients will present findings from their projects related to the effects of telehealth use on diabetes outcomes and geographic disparities, expanded telehealth coverage during the COVID-19 pandemic for critical care billing, and the relationship between geospatial healthcare accessibility and COVID infection and long COVID symptoms.

What: Findings from SBE Consortium Coordinating Center Pilot Project Grants

When: May 28, 2026 from 3-4 pm EST

Where: On Zoom (no registration required)

Presentations:

Effects of Telehealth Use on Diabetes Outcomes and Geographic Disparities – Preliminary Results
Speaker: Jessica Cao
Abstract: Telehealth has rapidly expanded since 2020. Direct evidence on optimal provider-patient contact frequency, balance and mix of telehealth use (in-person, video, audio and online) is still very limited. Also limited are the variations of telehealth use patterns and its effects on direct care outcomes across geographic regions. This study aims to evaluate the effects of telehealth use patterns (volume, balance and mix) on diabetes care outcomes. The study also examines how telehealth use and its effects vary across geographic regions with different levels of healthcare provider shortage and/or burdens of chronic diseases. This longitudinal study leverages electronic health records from 28 health systems in the Midwest US to obtain patient-level telehealth use patterns, twice-yearly validated metrics on diabetes outcomes, as well as patient-, provider- and system-level characteristics from 2019 to 2024. We categorized patients’ residence into six geographic groups – rural/urban, rural/urban advantaged and rural/urban underserved areas, which are based on 11 measures covering healthcare capacity, health and economic status at zip-code level. Linear probability models are used to estimate the average differences in diabetes outcomes across regions and the effects of telehealth use on exacerbating or alleviating these geographic differences. Our data identifies 2,410,977 unique patients and 37,735,615 care visits over five years. Each year about 397,000 patients were eligible for diabetes management and public reporting on 10 diabetes outcome metrics. Our preliminary results showed that while gaps in these metrics between rural and urban (average) areas are changing (in both magnitude and direction) over time, metrics in rural and urban underserved areas are consistently lower than their counterparts. Take all-or-none optimal outcome as an example. Compliance rates in rural and urban underserved areas were 5.6 (95% CI 4.7, 6.4) and 7.4 (6.8, 8.1) percentage points (pp) lower than the average 53.4% (53.0%, 53.8%). Patients who used telehealth in both rural and urban underserved areas showed significant increase in compliance rate by 5.1 (1.4, 8.9) and 4.0 (1.0, 6.9) pp, a relative 9.6% and 7.5% improvement in care outcome metrics. This study provided early evidence that optimal patterns of telehealth use for diabetes care management vary by care outcome metrics and across geographic regions. Patients in rural and rural underserved areas had fewer care visits overall, but higher telehealth use prevalence and penetration, suggesting a promising way of use telehealth to improve care and reduce gaps in care due to provider shortage. Patient in urban and urban underserved areas, though showed comparable benefits from using telehealth to improve care, had much lower telehealth use and penetration, implying the need for different focuses to improve care such as telehealth adoption, regular contact maintenance, etc.

Telemedicine Critical Care Billing For Hospitalized Medicare Fee-For-Service Beneficiaries, 2018-2024
Speaker: Karen Joynt Maddox
Abstract: Expanded coverage for telehealth during the COVID-19 pandemic allowed providers to bill for telemedicine services that were previously not reimbursable, including telemedicine critical care (TCC) services for critically ill patients. We aimed to characterize TCC billing practices among Medicare beneficiaries before, during, and after the COVID-19 pandemic. This was a serial cross-sectional study of adult Medicare Fee-For-Service beneficiaries with at least one bill for critical care at acute care hospitals from January 2018-September 2024. TCC billing was identified using provider billing codes; multivariate regression models were used to determine characteristics associated with receipt of TCC. Key outcomes were patient-, provider-, and hospital-level characteristics associated with TCC billing. Billing for TCC increased from 0.002% of critical care bills pre-pandemic to 0.01% of critical care bills during and after the pandemic. Patients billed for TCC were disproportionately likely to have COVID-19 but were otherwise relatively similar to critically ill patients not billed for TCC. Internal medicine/critical care providers accounted for the highest proportion of pandemic TCC bills (46.0%). TCC billing occurred more often at minor teaching hospitals (adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.03-1.43) and at safety net hospitals (aOR 1.33 [1.04-1.70]). TCC billing was less likely at small (aOR 0.39, 95% CI 0.26-0.58) and medium (aOR 0.67 [0.47-0.95]) sized hospitals, government owned (aOR 0.70 [0.57-0.86]) and for-profit hospitals (aOR 0.58 [0.48-0.71]), rural hospitals (aOR 0.70 [0.55-0.89]), and Critical Access Hospitals (aOR 0.59 [0.47-0.73]). Billing for TCC among hospitalized critically ill Medicare beneficiaries increased during the pandemic but remained low as a proportion of all critical care bills. There was variability in utilization across subspecialties and lesser utilization at rural and Critical Access Hospitals. Further studies are needed to characterize the clinical and economic consequences of this shift.

Geospatial Accessibility to Healthcare and COVID Outcomes: Evidence from Enhanced Two-Step Floating Catchment Area Analysis in South Carolina
Speaker: Sicheng Wang
Abstract: Transportation accessibility is a critical yet underexamined determinant of COVID-related health outcomes, particularly in the context of long COVID. While prior studies have documented social and spatial disparities in COVID impacts, less is known about how objectively measured access to healthcare services shapes infection risk and long-term post-infection outcomes. This study examines the relationship between geospatial healthcare accessibility and COVID infection and long COVID symptoms in South Carolina. Healthcare accessibility was measured using the Enhanced Two-Step Floating Catchment Area (E2SFCA) method, which accounts for healthcare supply, population demand, travel-time-based catchments, and distance decay. Travel times between ZIP code centroids and healthcare facilities were derived from network-based origin–destination analysis, with catchments defined at 0–20, 20–40, and 40–60 minutes. ZIP code–level accessibility scores were aggregated to the county level and linked to individual-level data from the Behavioral Risk Factor Surveillance System (BRFSS). Two outcomes were examined: (1) ever testing COVID-positive in the general population and (2) reporting long COVID symptoms among COVID-positive individuals. Generalized linear mixed-effects models were estimated to account for within-county correlation while controlling for demographic characteristics and social determinants of health. Geospatial healthcare accessibility was not significantly associated with COVID infection risk in the general population. However, among COVID-positive individuals, higher accessibility was associated with a significantly lower likelihood of reporting long COVID symptoms (adjusted odds ratio < 1, p < 0.05). These findings suggest that while healthcare accessibility may not reduce infection risk, it plays an important role in mitigating longer-term adverse health outcomes following COVID-19. By highlighting the relevance of transportation-based healthcare accessibility for long COVID, this study underscores the importance of targeted, place-based healthcare investments to reduce post-pandemic health disparities in underserved regions.