UC Berkeley

In response to the COVID-19 pandemic, telehealth was rapidly implemented to make remote care possible. While pre-pandemic levels of telehealth utilization were low generally, community health centers (CHCs) had particularly low adoption due to policy barriers and limited access for low-income populations. One major challenge in understanding telehealth utilization among patients of CHCs is disentangling patient preferences and barriers to use. For instance, low-income populations may prefer in-person care, but this option may be constrained by structural barriers, including employer flexibility for time off and financial considerations. Despite lingering volatility in the policy landscape, unclear patient preferences, and unique barriers to implementation, many CHCs accelerated telehealth implementation.

In order to address barriers relevant to CHCs, this dissertation examines factors that impact telehealth implementation. Chapter 1 is a systematic review conducted to understand factors that influence organizational adoption of telehealth in safety net settings and how to overcome barriers. Chapter 2 examines the association of care continuity with telehealth use and quality of diabetes and hypertension care in CHCs before and during the COVID-19 pandemic. Finally, Chapter 3, utilizes a conjoint experiment with a latent class analysis to unpack preferences and needs of underserved patients that impact patient adoption and acceptance of telehealth. The three analyses together advance evidence about successful telehealth implementation for underserved patient populations.