Trends in Outpatient Telemedicine Utilization Among Rural Medicare Beneficiaries, 2010 to 2019.
Trends in Outpatient Telemedicine Utilization Among Rural Medicare Beneficiaries, 2010 to 2019.
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DOI：
10.1001/jamahealthforum.2021.3282
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Mehrotra A
中科院分区：
文献类型：
--
作者：
Barnett ML;Huskamp HA;Busch AB;Uscher-Pines L;Chaiyachati KH;Mehrotra A
在新冠肺炎大流行之前的十年里，农村医疗保险受益人是如何使用远程医疗的？这项针对1,040万农村医疗保险受益人的横断面研究发现，2010年至2019年，医疗保险覆盖的农村受益人远程医疗使用量持续年复合增长，特别是护士从业人员和其他非医生临床医生提供的护理。患有严重精神疾病(如双相情感障碍)的医疗保险受益人在所有远程医疗访问中使用的比例不成比例，在美国891个县，每年有超过十分之一的受益人使用远程医疗。这项横断面研究的结果表明，在新冠肺炎大流行之前，有精神健康问题的联邦医疗保险受益人中远程医疗的使用迅速增长；2020年前在当地卫生保健环境中提供的远程医疗模式可能是在农村社区继续使用的一种可行模式。在2020年新冠肺炎大流行期间发生广泛变化之前，人们对远程医疗的使用是如何演变的知之甚少。了解远程医疗使用的流行模式可以为正在进行的关于远程医疗政策未来的辩论提供信息。描述新冠肺炎大流行之前联邦医疗保险按服务付费受益者使用远程医疗的趋势以及提供远程医疗的临床医生的专业。这是一项对2010年至2019年1040万按服务收费的医疗保险受益人的远程医疗利用情况的横断面研究和描述性分析。数据分析时间为2019年6月6日至2020年7月30日。远程医疗使用率、2010至2019年接受远程医疗的受益者的特点以及临床医生提供远程医疗的专业。在1,040万农村医疗保险受益人中，2019年有91483人使用远程医疗(年龄≥65岁，47 135[51.5%]；女性51 476[56.3%]；白人76 467[83.6%])。从2010年到2019年，远程医疗就诊每年增长23.1%。2019年，共有0.9%的农村服务收费受益者进行了远程医疗访问，而2010年这一比例为0.2%。2019年，每千名农村受益者有257次 979次远程医疗就诊，或34.8次就诊，其中大部分(75.9%)是心理健康问题。2019年，双相情感障碍或精神分裂症患者(占农村受益人的3.0%)接受了所有远程医疗就诊的40%。2019年，一些传统上处于不利地位和服务不足的群体在远程医疗用户中所占的比例高于非用户，例如那些参加医疗补助的双重保险用户(56.9%的用户对18.6%的非用户；调整后的奇比为3.83；95%的CI，3.77-3.89)。2010至2019年，针对精神健康问题的远程医疗从精神科医生(占所有远程医疗就诊的71.2%至35.8%)转向非内科临床医生，如执业护士、心理学家和社会工作者(21.4%至57.2%)。2019年各县的远程医疗使用率差异很大：中位数(IQR)，每1000名受益者中有16.0名(2.5-51.4)远程医疗用户)。在891个县(占美国所有县的29%)，2019年至少10%的双相情感障碍或精神分裂症受益人使用了远程医疗服务。在这项关于新冠肺炎大流行之前远程医疗利用情况的横断面研究中，医疗保险计划覆盖的农村受益人中的远程医疗访问持续增长，特别是由执业护士和其他非内科临床医生提供的护理。在当地保健环境中提供的远程医疗普及模式可能是在农村社区维持的一种可行的模式。这项横断面研究描述了2010年至2019年农村医疗保险受益者中远程医疗的使用趋势，以确定在新冠肺炎大流行之前正在使用的模式是否应该继续使用。
How was telemedicine used by rural Medicare beneficiaries in the decade prior to the COVID-19 pandemic? This cross-sectional study of 10.4 million rural Medicare beneficiaries found sustained annual compound growth in telemedicine use among rural beneficiaries covered by Medicare in 2010 to 2019, especially for care provided by nurse practitioners and other nonphysician clinicians. Medicare beneficiaries with serious mental illness (eg, bipolar disorder) used a disproportionate share of all telemedicine visits, with more than 1 in 10 beneficiaries using telemedicine annually in 891 counties in the US. The findings of this cross-sectional study indicate that telemedicine use grew rapidly before the COVID-19 pandemic among Medicare beneficiaries with mental health conditions; the model of telemedicine provided in the local health care setting before 2020 may be a viable modality for continued use in rural communities. Little is known about how telemedicine use was evolving before the broad changes that occurred during the COVID-19 pandemic in 2020. Understanding prepandemic patterns of telemedicine use can inform ongoing debates on the future of telemedicine policy. To describe trends in telemedicine utilization among Medicare fee-for-service beneficiaries before the COVID-19 pandemic and the specialties of clinicians providing telemedicine. This was a cross-sectional study and descriptive analysis of telemedicine utilization by 10.4 million fee-for-service Medicare beneficiaries from 2010 to 2019. Data analysis was performed from June 6, 2019, to July 30, 2020. Rates of telemedicine utilization, characteristics of beneficiaries who received telemedicine in 2010 to 2019, and specialties of clinicians delivering telemedicine. Of 10.4 million rural Medicare beneficiaries, telemedicine was used by 91 483 individuals (age ≥65 years, 47 135 [51.5%]; women, 51 476 [56.3%]; and White, 76 467 [83.6%] individuals) in 2019. In 2010 to 2019, telemedicine visits grew by 23.1% annually. A total of 0.9% of all fee-for-service rural beneficiaries had a telemedicine visit in 2019 compared with 0.2% in 2010. In 2019, there were 257 979 telemedicine visits or 34.8 visits per 1000 rural beneficiaries and most (75.9%) of these visits were for mental health conditions. Patients with bipolar disorder or schizophrenia (3.0% of rural beneficiaries) received 40% of all telemedicine visits in 2019. Some traditionally disadvantaged and underserved groups comprised a larger share of telemedicine users than nonusers in 2019, such as those dually insured with Medicaid (56.9% of users vs 18.6% of nonusers; adjusted odd ratio, 3.83; 95% CI, 3.77-3.89). In 2010 to 2019, telemedicine for mental health conditions shifted away from psychiatrists (71.2% to 35.8% of all telemedicine visits) to nonphysician clinicians, eg, nurse practitioners, psychologists, and social workers (21.4% to 57.2%). There was wide variation in telemedicine utilization in 2019 across counties: median (IQR), 16.0 (2.5-51.4) telemedicine users per 1000 beneficiaries). In 891 counties (29% of all US counties), at least 10% of beneficiaries with bipolar disorder or schizophrenia used a telemedicine service in 2019. In this cross-sectional study of telemedicine utilization before the COVID-19 pandemic, there was sustained growth in telemedicine visits among rural beneficiaries covered by the Medicare program, especially care delivered by nurse practitioners and other nonphysician clinicians. The prepandemic model of telemedicine provided in local health care settings may be a viable modality to maintain in rural communities. This cross-sectional study describes telemedicine utilization trends among rural Medicare beneficiaries from 2010 to 2019 to ascertain if the model being used before the COVID-19 pandemic should continue to be used.
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DOI：
10.1089/15305620260353171
发表时间：
2002-09-01
期刊：
TELEMEDICINE JOURNAL AND E-HEALTH
影响因子：
--
作者：
Agha, Z;Schapira, RM;Maker, AH
通讯作者：
Maker, AH
影响因子：
9.7
作者：
Mehrotra, Ateev;Huskamp, Haiden A.;Busch, Alisa B.
通讯作者：
Busch, Alisa B.
DOI：
10.1001/jama.2016.2186
发表时间：
2016-05-10
期刊：
JAMA
影响因子：
--
作者：
Mehrotra A;Jena AB;Busch AB;Souza J;Uscher-Pines L;Landon BE
通讯作者：
Landon BE
影响因子：
9.7
作者：
Barnett, Michael L.;Lee, Dennis;Frank, Richard G.
通讯作者：
Frank, Richard G.
DOI：
10.1089/153056203772744680
发表时间：
2003-12-01
期刊：
TELEMEDICINE JOURNAL AND E-HEALTH
影响因子：
--
作者：
Bynum, AB;Irwin, CA;Denny, GS
通讯作者：
Denny, GS