Understanding Use of Direct to Consumer Telemedicine for Pediatric Acute Respiratory Infections

儿科急性呼吸道感染（阿里斯）占年轻人门诊就诊的30%以上 儿童和超过50%的门诊就诊导致抗生素处方。许多阿里斯 病毒性和自限性，然而，即使是病毒性阿里斯的就诊也经常导致不必要的抗生素使用， 导致抗生素耐药性、治疗副作用和超过170亿美元的医疗保健支出 每年。因此，限制不必要的ARI就诊和减少不必要的ARI抗生素的努力 使用是美国医疗保健系统的高度优先事项。这些努力面临着新的挑战， 直接面向消费者（DTC）的远程医疗作为儿科阿里斯的护理选择的出现。通过启用 “随时随地”获得护理，DTC远程医疗提供了更好的及时性和可及性， 但也与ARI就诊量增加和更多不必要的抗生素使用有关。与 DTC远程医疗的新选择，父母必须浏览几个护理选项，每个都有潜力 质量领域相对于替代品的收益和损失。然而，我们对父母是如何 在一般感知质量和DTC远程医疗中进行权衡， 对ARI寻求护理做出决定。本提案的总体目标是解决这一关键问题， 通过全面了解儿科寻求护理的决定， DTC远程医疗背景下的阿里斯。在目标1中，我们将使用严格的决策科学方法， 确定父母在决定寻求照顾孩子时使用的“心理模型”， 通过DTC远程医疗的ARI与其他选项。在目标2中，我们将采用稳健的定量方法 确定与使用DTC远程医疗治疗阿里斯相关的患者、家庭和卫生系统因素 在国家商业索赔数据中，补充了我们对母公司决定的微观审查 通过这种对护理模式的宏观层面的检查。在目标3中，我们将研究母公司的权衡 通过离散选择实验确定急性护理模式特定属性的阈值。这一目标 我将整合我们前两个目标的发现，要求父母在两对护理之间做出选择， 具有不同级别的关键属性（在目标1中确定）的选项，允许识别偏好 全样本和有差别使用DTC的亚组的交易意愿阈值 阿里斯远程医疗（目标2中确定）。该项目将应用严格的决策科学工具， DTC远程医疗，在没有充分了解的情况下，正在迅速用于儿科阿里斯 它对寻求护理决定的影响。总之，这些目标将为护理提供重要的见解- 当优先级冲突时寻求决策（例如，及时性与安全性），从而为未来的决策提供信息 支助工具、干预措施设计和评价，以及付款人和决策者有关 用于儿科阿里斯的DTC远程医疗。

Pediatric acute respiratory infections (ARIs) account for over 30% of outpatient visits by young children and for over 50% of the outpatient visits that result in antibiotic prescriptions. Many ARIs are viral and self-limited, yet visits even for viral ARIs frequently result in unnecessary antibiotic use, leading to antibiotic resistance, treatment side effects, and health care spending exceeding $17 billion annually. As a result, efforts to limit unnecessary ARI visits and reduce unnecessary ARI antibiotic use are a high priority for the US health care system. These efforts face a new challenge in the emergence of direct-to-consumer (DTC) telemedicine as a care option for pediatric ARIs. By enabling access to care “anywhere, anytime,” DTC telemedicine offers improved timeliness and accessibility, but is also associated with increased volume of ARI visits and more unnecessary antibiotic use. With the new option of DTC telemedicine, parents must navigate several care options, each with potential gains and losses in quality domains relative to alternatives. Yet little is known about how parents approach tradeoffs in perceived quality in general and with DTC telemedicine specifically when making decisions about ARI care-seeking. The overall goal of this proposal is to address this critical knowledge gap by developing a comprehensive understanding of care-seeking decisions for pediatric ARIs in the context of DTC telemedicine. In Aim 1, we will use rigorous decision science methods to identify the “mental models” that parents use when making decisions about seeking care for a child’s ARI via DTC telemedicine versus other options. In Aim 2 we will employ robust quantitative methods to identify patient, family, and health system factors associated with use of DTC telemedicine for ARIs in national commercial claims data, complementing our micro-level examination of parent decision making with this macro-level examination of patterns of care. In Aim 3 we will examine parent tradeoff thresholds for specific attributes of acute care models through a discrete choice experiment. This aim will integrate the findings from our first two aims, asking parents to choose between pairs of care options with varying levels of key attributes (identified in Aim 1), allowing identification of preferences and willingness-to-trade thresholds for the full sample and for subgroups with differential use of DTC telemedicine for ARIs (identified in Aim 2). This project will apply rigorous decision science tools to DTC telemedicine, which is being rapidly adopted for pediatric ARIs without adequate understanding of its impact on care-seeking decisions. Together, these aims will provide critical insight into care- seeking decisions when priorities conflict (e.g., timeliness vs. safety) thereby informing future decision support tools, intervention design and evaluation, and payer and policy-maker decisions related to DTC telemedicine for pediatric ARIs.