Designing equitable telehealth solutions for outpatient surgical care in a safety-net population: a human-centered design approach.

BACKGROUND: The SARS CoV-2 (COVID-19) pandemic catalyzed a dramatic shift in healthcare delivery, with telemedicine emerging as a common mode of care provision. While pre-pandemic telemedicine services were more commonly used for preventive visits and had better adherence among younger and more affluent demographics, the landscape of telehealth in the post-pandemic period has shifted significantly to include surgical visits and publicly-insured patient populations. Without specific insights from patients and clinicians to guide this transition, telehealth delivery risks exacerbating disparities in access, experience and outcomes for medically underserved populations.

METHODS: We utilized a human-centered design (HCD) approach to gain insights into patient and clinician perspectives on telehealth delivery at a surgical outpatient clinic in an urban safety-net hospital and level 1 trauma center. During the Inspiration phase of HCD, we conducted 19 in-depth interviews with patients and surgical clinicians, and applied a combined thematic analysis and design synthesis approach to identify key insight statements representing actionable tensions across cohorts. During the Ideation phase of HCD, we held a structured brainstorming session to identify solutions and facilitated a discussion with surgical faculty to co-design and refine a prototype.

RESULTS: Interview analysis revealed 12 main themes, which were then reorganized into 5 core insights across both groups: "In-person appointments can be resource intensive for patients, making their attendance costly in more ways than one"; "When sacrificing connection for convenience, telehealth exacerbates discrimination felt by historically marginalized patients"; "Personal interactions are crucial for establishing new relationships and repairing mistrust between patients and clinicians"; "Visual cues and non-verbal communication are essential for personalized and effective surgical care"; "Patients and clinicians value the human infrastructure built into the in-person visit experience." Brainstorming participants generated ideas from the first insight statement. Subsequent prototyping and co-design sessions led to the development of a screening prototype allowing both clinic staff and patients to book telehealth appropriate appointments.

CONCLUSIONS: This study offers a HCD approach to developing insights and tailoring health service interventions to the local contexts for safety-net providers. By understanding the unique needs and preferences of underserved populations, we can develop telehealth interventions that increase adoption and ensure equitable access to care.