Moving Towards Equity With Digital Health Innovations for Stroke Care

Abstract

Digital health has long been championed as a means to expanding access to health care. Now that the COVID-19 pandemic accelerated many health systems’ integration of digital tools for care, digital health may provide a path towards more accessible stroke prevention and treatment, particularly for historically disadvantaged patient populations. Stroke management is composed of multiple time points where digital health innovations have the potential to augment health access and treatment: from primary prevention, to the time-sensitive detection of ischemic stroke, administration of thrombolytic agents and consideration for endovascular interventions, to appropriate post-acute care, rehabilitation, and lifelong secondary stroke prevention—stroke care relies on a multidisciplinary and standardized approach. However, as we discuss pointedly in this Focused Update, underrepresented individuals face multilevel digital health disparities that potentially diminish the benefits of these digital advances. As such, these multilevel needs must be discussed and accounted for as health systems seek to integrate innovative and equitable digital health solutions towards stroke care.

Telehealth’s Role Enabling Sustainable Innovation and Circular Economies in Health

“…77 This calls for wide reform, nimble regulation, and sustained innovation to address the innovators and data value predicaments. A digital innovation acceleration superstructure that connects DHIs across the care continuum, comprising standards, aligned and enabling telehealth-based governance and regulatory policies that can (1) enable data resource innovation, (2) address the pressing governance and transparency issues inhibiting DHIs from expanding into the space of community-health and public health, (3) lend structure to real-world data for trusted evidence, (4) provide a new pathway to radically different structures in delivery models, (5) reduce healthcare worker's workload, (6) improve outreach, engagement, and prevention at scale, all while (7) collecting structured data.…”

“…Digital health interventions support a broad range of first-order improvement results, including the discovery of new knowledge on disease and treatments using artificial intelligence (AI), real-world evidence (RWE) for health technology assessments and clinical trials, better informed clinical and policy decisions, patient engagement and continuity-of-care, expanding access to care, and transformation of healthcare. 5,6 Digital phenotyping is an emerging DHI paradigm that relies on smartphones and wearables to support the continuity of care and improve scalability. [7][8][9][10][11][12][13][14][15] Multiple reviews have examined the positive evidence for effectiveness, cost-effectiveness, patient perceptions, and effects of telehealth on mortality.…”

Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations

“…114 The lack of access to or familiarity with digital technology could result in minority populations having less access to relevant information, resources, or strategies necessary to facilitate care transitions, recovery and risk factor control. 115,116 More research focused on community reintegration is also needed. Successful community reintegration involves moving from the short term focus of restoring physical function to establishing patient independence while adjusting their expectations.…”

“…114 The lack of access to or familiarity with digital technology could result in minority populations having less access to relevant information, resources, or strategies necessary to facilitate care transitions, recovery and risk factor control. 115,116…”

The Syndemic of Inequity and COVID-19 in Virtual Care

“…The emergency management of health care in the pandemic era inadvertently proved the critical role of the social determinants of health through data about the rapid viral spread in largely marginalized, resource-challenged communities [ 3 ]. Based on the presence of similar contexts like the digital divide along pathways of structural inequities, COVID-19 has been characterized as a syndemic as opposed to a pandemic [ 4 ], emphasizing the intersections of the contributing demographic, social, economic, and environmental factors of the pandemic.…”