National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Autism (1)
- Behavioral Health (1)
- Caregiving (4)
- Children/Adolescents (7)
- Chronic Conditions (2)
- Clinician-Patient Communication (1)
- Comparative Effectiveness (1)
- COVID-19 (1)
- Critical Care (1)
- Cultural Competence (1)
- Diabetes (3)
- Digestive Disease and Health (2)
- Education: Patient and Caregiver (3)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Emergency Department (3)
- Emergency Medical Services (EMS) (1)
- Healthcare Costs (1)
- Healthcare Delivery (1)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (14)
- Health Services Research (HSR) (1)
- Hospitalization (1)
- Hospitals (1)
- Human Immunodeficiency Virus (HIV) (1)
- Injuries and Wounds (1)
- Long-Term Care (1)
- Medication (1)
- Medication: Safety (1)
- Nursing (1)
- Obesity (1)
- Outcomes (1)
- Patient-Centered Outcomes Research (3)
- Patient Adherence/Compliance (1)
- Patient Safety (3)
- Patient Self-Management (3)
- Practice Patterns (1)
- Primary Care (2)
- Provider: Nurse (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (2)
- Rural Health (4)
- Sickle Cell Disease (1)
- Social Media (1)
- Substance Abuse (1)
- Surgery (1)
- Teams (1)
- (-) Telehealth (24)
- Vulnerable Populations (1)
- Web-Based (2)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 24 of 24 Research Studies DisplayedHahn AL, Michaels CL, Khawly G
Comparison of evaluation methods for improving the usability of a Spanish mHealth tool.
The purpose of this study was to compare two usability evaluation methods for adapting an evidence-based mHealth tool from English into Spanish. The authors conducted cognitive interviews and usability assessments using a think-aloud protocol to evaluate the usability of an HIV mHealth application among 40 Spanish-speaking adults with HIV in New York City and in La Romana in the Dominican Republic. Findings highlighted contributions and limitations of including these methods in mHealth usability testing. The authors concluded that future research should employ a multi-method approach that incorporated complementary usability evaluation methods and engaged participants in multiple assessments.
AHRQ-funded; HS028523.
Citation: Hahn AL, Michaels CL, Khawly G .
Comparison of evaluation methods for improving the usability of a Spanish mHealth tool.
Int J Med Inform 2024 Apr; 184:105355. doi: 10.1016/j.ijmedinf.2024.105355.
Keywords: Telehealth, Health Information Technology (HIT)
Bratches RWR, Onsando W, Puga F
Family caregiver comfort with telehealth technologies: differences by race and ethnicity in a cross-sectional survey.
This study’s objective was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. The authors conducted a secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Likert-style questions were used to determine the level of caregiver comfort using computers, smartphones, and tablets. There was a total of 340 caregivers included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.1) of expressing comfort using computers; black caregivers (OR 0.46) and Hispanic caregivers (OR 0.36) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64) of expressing comfort using tablets.
AHRQ-funded; HS013852.
Citation: Bratches RWR, Onsando W, Puga F .
Family caregiver comfort with telehealth technologies: differences by race and ethnicity in a cross-sectional survey.
Telemed J E Health 2024 Mar; 30(3):685-91. doi: 10.1089/tmj.2023.0314..
Keywords: Telehealth, Health Information Technology (HIT), Caregiving, Racial and Ethnic Minorities
Bui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Weiss CR, Roberts M, Florell M
Best Practices for telehealth in nurse-led care settings-a qualitative study.
This study explored the implementation of telehealth in nurse-led care models during the COVID-19 pandemic in Colorado. Through interviews with 18 providers and 30 patients, best practices such as: using multiple modalities, tailored triage and scheduling, safety measures, and managing patient relationships emerged. These findings indicate that telehealth can enhance equitable care delivery, particularly in diverse communities, with nurse leaders playing a vital role in its effective utilization.
AHRQ-funded; HS028085.
Citation: Weiss CR, Roberts M, Florell M .
Best Practices for telehealth in nurse-led care settings-a qualitative study.
Policy Polit Nurs Pract 2024 Feb; 25(1):47-57. doi: 10.1177/15271544231201417.
Keywords: Telehealth, Health Information Technology (HIT), Nursing, Provider: Nurse, COVID-19
Sequeira GM, Asante PG, Bocek K
Evaluating an electronic consultation platform to support pediatric primary care providers in caring for transgender and nonbinary adolescents.
An electronic consultation (e-consult) platform was introduced to conduct a study to aid pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. A study assessed its impact on PCP confidence and referral patterns. Results showed increased confidence and a 19% decrease in specialty referrals among PCPs. The platform received positive usability feedback, suggesting its potential to enhance care access and reduce specialty referrals for TNB adolescents.
AHRQ-funded; HS026393.
Citation: Sequeira GM, Asante PG, Bocek K .
Evaluating an electronic consultation platform to support pediatric primary care providers in caring for transgender and nonbinary adolescents.
Telemed J E Health 2024 Feb; 30(2):595-600. doi: 10.1089/tmj.2023.0266.
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Primary Care, Vulnerable Populations
Olaya F, Brin M, Caraballo PB
A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol.
The purpose of this study is to test the effectiveness of an mHealth tool to improve adherence to HIV medication in Spanish-speaking people living in New York City and the Dominican Republic. The researchers developed the WiseApp study as a two-arm randomized controlled trial. The 248 participants from New York and the Dominican Republic were randomly assigned to receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or to the standard of care (control). The participants completed surveys at the baseline, 3-month, 6-month, and 12-month follow-up visits. Through blood draws at each study timepoint, the study team collected HIV-1 viral load and CD4 count results. Results will be forthcoming.
AHRQ-funded; HS028523.
Citation: Olaya F, Brin M, Caraballo PB .
A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol.
BMC Public Health 2024 Jan 17; 24(1):201. doi: 10.1186/s12889-023-17538-y..
Keywords: Human Immunodeficiency Virus (HIV), Telehealth, Health Information Technology (HIT), Cultural Competence, Outcomes
Jolliff A, Coller RJ, Kearney H
An mHealth design to promote medication safety in children with medical complexity.
This study describes an effort to design a health information technology tool to improve medication safety for children with medical complexity (CMC). The study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a co-design process to identify: 1) medication safety challenges experienced by CMC caregivers and, 2) design requirements for a mobile health application to improve medication safety for CMC in the home. Family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program participated in virtual co-design sessions. During these sessions, the facilitator guided 16 co-designers in generating and converging upon medication safety challenges and design requirements. These sessions were recorded and reviewed after conclusion to confirm that all designer comments had been captured. An analysis yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines.
AHRQ-funded; HS028409.
Citation: Jolliff A, Coller RJ, Kearney H .
An mHealth design to promote medication safety in children with medical complexity.
Appl Clin Inform 2024 Jan; 15(1):45-54. doi: 10.1055/a-2214-8000..
Keywords: Children/Adolescents, Medication: Safety, Medication, Health Information Technology (HIT), Chronic Conditions, Telehealth, Caregiving
Shah MN, Wasserman EB, Gillespie SM
High-intensity telemedicine decreases emergency department use for ambulatory care sensitive conditions by older adult senior living community residents.
The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs). It found that providing acute illness care by high-intensity telemedicine to older adults residing in SLCs significantly decreases the rate of ED use for ACSCs over 1 year.
AHRQ-funded; HS018047.
Citation: Shah MN, Wasserman EB, Gillespie SM .
High-intensity telemedicine decreases emergency department use for ambulatory care sensitive conditions by older adult senior living community residents.
J Am Med Dir Assoc 2015 Dec;16(12):1077-81. doi: 10.1016/j.jamda.2015.07.009..
Keywords: Elderly, Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Long-Term Care
Lee YJ, Boden-Albala B, Jia H
The association between online health information-seeking behaviors and health behaviors among Hispanics in New York City: a community-based cross-sectional study.
The specific aim of this study was to examine the association between online health information-seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics. It concluded that given the promising, although modest, associations between online health information-seeking behaviors and some health behaviors, efforts are needed to improve Hispanics' ability to access and understand health information.
AHRQ-funded; HS022961; HS019853.
Citation: Lee YJ, Boden-Albala B, Jia H .
The association between online health information-seeking behaviors and health behaviors among Hispanics in New York City: a community-based cross-sectional study.
J Med Internet Res 2015 Nov 26;17(11):e261. doi: 10.2196/jmir.4368.
.
.
Keywords: Education: Patient and Caregiver, Web-Based, Telehealth, Patient Adherence/Compliance, Racial and Ethnic Minorities
McConnochie KM
Pursuit of value in connected healthcare.
The authors highlighted differences in care models to mitigate controversy and to distinguish capacities of these different models. They concluded that the pursuit of value in connected care is fundamentally the same as with in-person care.
AHRQ-funded; HS016871; HS015165; HS018912.
Citation: McConnochie KM .
Pursuit of value in connected healthcare.
Telemed J E Health 2015 Nov;21(11):863-9. doi: 10.1089/tmj.2015.0111.
.
.
Keywords: Healthcare Delivery, Quality of Care, Health Services Research (HSR), Telehealth
Cherrington AL, Agne AA, Lampkin Y
Diabetes Connect: developing a mobile health intervention to link diabetes community health workers with primary care.
The authors tested a model for the integration of a community health worker-delivered mobile health technology intervention to improve diabetes self-management. They found that the integration of mobile health technology into community health worker programs was successfully achieved and readily accepted.
AHRQ-funded; HS019465.
Citation: Cherrington AL, Agne AA, Lampkin Y .
Diabetes Connect: developing a mobile health intervention to link diabetes community health workers with primary care.
J Ambul Care Manage 2015 Oct-Dec;38(4):333-45. doi: 10.1097/jac.0000000000000110.
.
.
Keywords: Education: Patient and Caregiver, Diabetes, Primary Care, Patient Self-Management, Telehealth
Wiseman JT, Fernandes-Taylor S, Barnes ML
Conceptualizing smartphone use in outpatient wound assessment: patients' and caregivers' willingness to use technology.
The researchers surveyed a vulnerable patient population to evaluate smartphone capability and willingness to adopt this technology. Their survey demonstrated that an older patient cohort with significant comorbidity is able and willing to adopt a smartphone-based postoperative monitoring program.
AHRQ-funded; HS023395.
Citation: Wiseman JT, Fernandes-Taylor S, Barnes ML .
Conceptualizing smartphone use in outpatient wound assessment: patients' and caregivers' willingness to use technology.
J Surg Res 2015 Sep;198(1):245-51. doi: 10.1016/j.jss.2015.05.011..
Keywords: Ambulatory Care and Surgery, Surgery, Telehealth, Health Information Technology (HIT), Injuries and Wounds, Adverse Events, Patient Safety, Caregiving
Chung CF, Cook K, Bales E
More than telemonitoring: Health provider use and nonuse of life-log data in irritable bowel syndrome and weight management.
The researchers sought to develop an in-depth understanding of providers’ facilitators and barriers to successfully integrating life-log data into their practices and creating better experiences. Providers reported using self-monitoring data to enhance provider-patient communication, develop personalized treatment plans, and to motivate and educate patients, in addition to using them as diagnostic and adherence tools. Barriers included a lack of time to review detailed records and questions about providers' expertise to review it.
AHRQ-funded; HS023654.
Citation: Chung CF, Cook K, Bales E .
More than telemonitoring: Health provider use and nonuse of life-log data in irritable bowel syndrome and weight management.
J Med Internet Res 2015 Aug 21;17(8):e203. doi: 10.2196/jmir.4364..
Keywords: Digestive Disease and Health, Health Information Technology (HIT), Telehealth, Obesity, Clinician-Patient Communication
Yang NH, Dharmar M, Yoo BK
Economic evaluation of pediatric telemedicine consultations to rural emergency departments.
The researchers conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. They found that treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. They concluded that telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving or cost-effective compared with telephone consultations.
AHRQ-funded; HS013179.
Citation: Yang NH, Dharmar M, Yoo BK .
Economic evaluation of pediatric telemedicine consultations to rural emergency departments.
Med Decis Making 2015 Aug;35(6):773-83. doi: 10.1177/0272989x15584916.
.
.
Keywords: Healthcare Costs, Emergency Department, Children/Adolescents, Rural Health, Telehealth
McConnochie KM, Ronis SD, Wood NE
Effectiveness and safety of acute care telemedicine for children with regular and special healthcare needs.
The authors assessed the hypothesis that effectiveness and safety of the Health-e-Access telemedicine model for care of children with special healthcare needs (CSHCN) with acute illness equaled those for care of children in regular childcare and schools (CRS). They concluded that observations support safety and effectiveness of Health-e-Access telemedicine for both CSHCN and CRS.
AHRQ-funded; HS016871; HS015165; HS018912.
Citation: McConnochie KM, Ronis SD, Wood NE .
Effectiveness and safety of acute care telemedicine for children with regular and special healthcare needs.
Telemed J E Health 2015 Aug;21(8):611-21. doi: 10.1089/tmj.2014.0175.
.
.
Keywords: Critical Care, Children/Adolescents, Patient Safety, Patient-Centered Outcomes Research, Telehealth
Ray KN, Demirci JR, Bogen DL
Optimizing telehealth strategies for subspecialty care: recommendations from rural pediatricians.
The authors elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. Rural pediatricians from 17 states described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians, through semistructured telephone interviews, provided recommendations for optimizing individual telehealth strategies.
AHRQ-funded; HS022989.
Citation: Ray KN, Demirci JR, Bogen DL .
Optimizing telehealth strategies for subspecialty care: recommendations from rural pediatricians.
Telemed J E Health 2015 Aug;21(8):622-9. doi: 10.1089/tmj.2014.0186.
.
.
Keywords: Children/Adolescents, Children/Adolescents, Practice Patterns, Rural Health, Telehealth
Perez SL, Paterniti DA, Wilson M
Characterizing the processes for navigating internet health information using real-time observations: a mixed-methods approach.
The researchers aimed to describe the processes by which users navigate the Internet for information about a hypothetical acute illness and to identify individual characteristics predictive of their information-seeking strategies. They identified and classified two approaches to processing Internet health information: System 1(41 percent, 32/78) unconscious, rapid, automatic, and high capacity processing and System 2 (59 percent, 46/78) conscious, slow, and deliberative processing.
AHRQ-funded; HS022236.
Citation: Perez SL, Paterniti DA, Wilson M .
Characterizing the processes for navigating internet health information using real-time observations: a mixed-methods approach.
J Med Internet Res 2015 Jul 20;17(7):e173. doi: 10.2196/jmir.3945..
Keywords: Education: Patient and Caregiver, Web-Based, Telehealth
Lepard MG, Joseph AL, Agne AA
Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review.
The authors systematically reviewed the evidence for the impact of diabetes self-management education interventions designed for patients living in rural areas on glycemic control and other diabetes outcomes. They were able to identify examples of both telehealth interventions and face-to-face interventions that resulted in improved behavioral, biologic, and diabetes knowledge-related outcomes in adults with T2DM living in rural areas.
AHRQ-funded; HS019465.
Citation: Lepard MG, Joseph AL, Agne AA .
Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review.
Curr Diab Rep 2015 Jun;15(6):608. doi: 10.1007/s11892-015-0608-3..
Keywords: Diabetes, Patient Self-Management, Rural Health, Telehealth, Health Information Technology (HIT)
Segall N, Hobbs G, Granger CB
Patient load effects on response time to critical arrhythmias in cardiac telemetry: a randomized trial.
This study compared response times to ventricular fibrillation across five patient loads: 16, 24, 32, 40, and 48 patients. The simulation replicated the work of telemetry watchers using a combination of real recorded patient electrocardiogram signals and a simulated patient experiencing ventricular fibrillation. It found that as participants monitored more patients in a laboratory setting, their performance with respect to recognizing critical and noncritical events declined.
AHRQ-funded; HS021332.
Citation: Segall N, Hobbs G, Granger CB .
Patient load effects on response time to critical arrhythmias in cardiac telemetry: a randomized trial.
Crit Care Med 2015 May;43(5):1036-42. doi: 10.1097/ccm.0000000000000923..
Keywords: Health Information Technology (HIT), Patient Safety, Telehealth
Mohd Roffeei SH, Abdullah N, Basar SK
Seeking social support on Facebook for children with autism spectrum disorders (ASDs).
This study examined the types of social support messages exchanged between parents and/or caregivers of children with Autism Spectrum Disorders (ASDs) who communicate via Facebook. It found that the highest percentage of messages offered dealt with informational support (30.7 percent) followed by emotional support (27.8 percent). Network and esteem support messages were responsible for 20.97 percent and 20.2 percent, respectively.
AHRQ-funded; HS018809.
Citation: Mohd Roffeei SH, Abdullah N, Basar SK .
Seeking social support on Facebook for children with autism spectrum disorders (ASDs).
Int J Med Inform 2015 May;84(5):375-85. doi: 10.1016/j.ijmedinf.2015.01.015..
Keywords: Social Media, Children/Adolescents, Caregiving, Telehealth, Autism
Cross RK, Jambaulikar G, Langenberg P
TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD): design and implementation of randomized clinical trial.
This study compares disease activity and quality of life over 1 year in a randomized trial of IBD patients receiving standard care versus telemedicine. If effective, telemedicine should decrease symptoms, improve quality of life, and decrease health care utilization. The burden associated with use of telemedicine for patients and providers needs to be assessed. This trial is ongoing and will be completed in July 2016.
AHRQ-funded; HS018975.
Citation: Cross RK, Jambaulikar G, Langenberg P .
TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD): design and implementation of randomized clinical trial.
Contemp Clin Trials 2015 May;42:132-44. doi: 10.1016/j.cct.2015.03.006..
Keywords: Comparative Effectiveness, Digestive Disease and Health, Health Information Technology (HIT), Patient-Centered Outcomes Research, Telehealth
Fuji KT, Abbott AA, Galt KA
A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record.
The authors explored how patients with type 2 diabetes used a personal health record (PHR) to manage their diabetes-related health information for self-care. They found that, despite some potential positive benefits resulting from PHR use, several barriers inhibited sustained and effective use over time. They concluded that provider and patient education about the benefits of PHR use and about the potential for filling in information gaps in the provider-based record is key to engage patients and stimulate PHR adoption and use.
AHRQ-funded; HS018625.
Citation: Fuji KT, Abbott AA, Galt KA .
A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record.
Telemed J E Health 2015 Apr;21(4):296-300. doi: 10.1089/tmj.2014.0084.
.
.
Keywords: Diabetes, Electronic Health Records (EHRs), Patient Self-Management, Telehealth
Yang NH, Dharmar M, Kuppermann N
Appropriateness of disposition following telemedicine consultations in rural emergency departments.
The researchers compared the overall and stratified observed-to-expected hospital admission ratios between telemedicine and telephone cohorts of acutely ill and injured children. They found that there were no statistically significant differences between the observed-to-expected admission ratios using Pediatric Risk of Admission II and Revised Pediatric Emergency Assessment Tool.
AHRQ-funded; HS013179; HS019712.
Citation: Yang NH, Dharmar M, Kuppermann N .
Appropriateness of disposition following telemedicine consultations in rural emergency departments.
Pediatr Crit Care Med 2015 Mar;16(3):e59-64. doi: 10.1097/pcc.0000000000000337..
Keywords: Children/Adolescents, Emergency Medical Services (EMS), Hospitalization, Rural Health, Telehealth
Jonassaint CR, Shah N, Jonassaint J
Usability and feasibility of an mHealth intervention for monitoring and managing pain symptoms in Sickle Cell Disease: The Sickle Cell Disease Mobile Application to Record Symptoms via Technology (SMART).
This article describes the feasibility of the Sickle cell disease Mobile Application to Record symptoms via Technology (SMART), an mHealth app developed to help sickle cell disease patients monitor and manage their day-to-day symptoms. The researchers concluded that that SMART is a useable and feasible method for monitoring daily pain symptoms among adolescents and adults with sickle cell disease-related pain.
AHRQ-funded; HS022989.
Citation: Jonassaint CR, Shah N, Jonassaint J .
Usability and feasibility of an mHealth intervention for monitoring and managing pain symptoms in Sickle Cell Disease: The Sickle Cell Disease Mobile Application to Record Symptoms via Technology (SMART).
Hemoglobin 2015;39(3):162-8. doi: 10.3109/03630269.2015.1025141..
Keywords: Chronic Conditions, Health Information Technology (HIT), Patient-Centered Outcomes Research, Sickle Cell Disease, Telehealth