Leveraging a Locally Anchored Learning Health Care System Toward Equitable Telehealth: Assessing Broadband Access and Supporting Use of Federal Internet Subsidies in a Safety-Net Setting

Abstract

Objective

To understand patients' access to telehealth and broadband and interest in the Affordable Connectivity Program (ACP) in an urban, safety-net setting, using community-engaged iterative learning cycles to improve patient-centered care.

Data Sources and Study Setting

Roots Community Health, a health center focused on uplifting those impacted by systemic inequities, functions as a community-anchored learning health system (LHS). Community was engaged in data collection and intervention development through Roots' Telehealth Patient Advisory Council. A cross-sectional survey was administered to adult patients.

Study Design

Roots designed and implemented an intervention to connect patients to digital access resources, including a 66-item questionnaire capturing patients' telehealth experience and barriers, device and broadband access, and awareness of ACP—a federal benefit providing up to $30 monthly toward internet for low-income households. Patients interested in ACP were offered enrollment support.

Data Collection Methods

Patients were screened for ACP interest and eligibility and offered survey participation, in-person or by phone by trained clinic staff and volunteers.

Principal Findings

One hundred nine patients were screened for ACP eligibility and interest; 99 completed the survey. Two-thirds (65/99) had experience with telehealth and 53% (52/99) were interested in future telehealth appointments. Patients reported several notable barriers: slow internet (46/98), no Internet access (40/99), mobile data plan issues (31/98), and downloading/using the telehealth software (31/98). Surveyed patients frequently reported utilizing the Internet for resources categorizable as Social Drivers of Health (SDOH). Most screened patients (65/109) had not heard of ACP, but over half (60/109) reported interest in applying.

Conclusions

Using a community-embedded LHS approach, we found that broadband connectivity is crucial for equitable telehealth access, an essential part of healthcare in clinics that aim to remedy persistent health inequities affecting people of African descent. Policy and advocacy should prioritize this SDOH, while healthcare organizations evaluate their role in broadband policy to improve equity.