Association between broadband capacity and telehealth utilization among Medicare Fee-for-service beneficiaries during the COVID-19 pandemic

Abstract

Background Telehealth is a rapidly growing modality for expanding healthcare access, especially in the post-COVID-19 era. However, telehealth requires high-quality broadband, thus making broadband a social determinant of health. The objective of this study was to evaluate the association between broadband access and telehealth utilization across the United States during the COVID-19 pandemic. Methods Using a cross-sectional, ecological study design, we merged county-level data on broadband capacity (Microsoft's Rural Broadband Initiative), telehealth utilization among Medicare Fee-for-Service beneficiaries from January through September 2020 (CareJourney), and county-level socioeconomic characteristics (Area Health Resources Files). Multivariable linear regression was used to estimate the association between broadband capacity, county-level characteristics, and telehealth utilization. Results Among the 3107 counties, those with the greatest broadband availability (quintile 5) had 47% higher telehealth utilization compared to counties with the least broadband availability (quintile 1). In the adjusted model, a 1 standard deviation (SD) increase in broadband access was associated with a 1.54 percentage point (pp) increase in telehealth utilization (P < 0.001). Rural county designation (−1.96 pp; P < 0.001) and 1 SD increases in average Medicare beneficiary age (−1.34 pp; P = 0.001), number of nursing home beds per 1000 individuals (−0.38 pp; P = 0.002), and proportion of Native Americans/Pacific Islanders (−0.59 pp; P < 0.001) were associated with decreased telehealth utilization. Conclusion The association between broadband access and telehealth utilization and the decreased telehealth utilization in rural areas highlight the importance of broadband access for healthcare access and the need to continue investing in broadband infrastructure to promote equitable healthcare access across populations.

Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19

“…Access to HSI emerged as a key factor related to telehealth use. These findings align with prior literature suggesting that HSI expansion would increase primary care receipt . However, differences in telehealth use by sex, geography, age, and income persisted among those with HSI, suggesting that HSI expansion would not close utilization gaps for these groups.…”

“…These findings align with prior literature suggesting that HSI expansion would increase primary care receipt. 33 , 49 , 50 However, differences in telehealth use by sex, geography, age, and income persisted among those with HSI, suggesting that HSI expansion would not close utilization gaps for these groups. Adding complexity, exploratory analyses identified 20% of post-PHE visits as phone-only, inspiring mechanistic questions about how HSI promotes telehealth.…”

“…28,31 Of the various factors impacting telehealth utilization, high-speed internet (HSI) may play a pivotal role in promoting telehealth. 8,19,20,32 In rural 33 and urban areas alike, 34 access to broadband internet is associated with greater individual-and neighborhood-level telehealth use. 20,35 As such, broadband availability may represent a key policy intervention to promote telehealth equity.…”

Development of an Implementation Science Telehealth Toolkit to Promote Research Capacity in Evaluation of Telehealth Programs

“…Similarly, despite telehealth being an effective tool to support health care access in rural communities, rural patients were less likely to engage in telehealth during the COVID-19 pandemic compared with urban patients. 9 , 37 There also have been reported disparities in use of telehealth among different patient populations due to various demographic characteristics and social determinants of health. 8 , 9 , 11 , 34 …”

Digital Technology Use Among Older Adults With Vision Impairment

“…However, the recent COVID-19 pandemic has exposed many disparities surrounding key digital determinants of health. 6,7 Although recent research has shown greater telehealth use in areas of better broadband access, 8 more than 25% of the US population still lacks proper access to broadband internet. 9 Furthermore, older adults with chronic disease tend to use telemedicine less than adults younger than 56 years, 10 as some do not feel confident navigating telehealth platforms or accommodating to smaller screens and text.…”