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

儿童急性呼吸道感染(ARI)占青少年门诊就诊的30%以上 对于儿童和超过50%的门诊结果是抗生素处方。许多ARI人是 病毒和自我限制，但即使是病毒ARI的访问也经常导致不必要的抗生素使用， 导致抗生素耐药性、治疗副作用和医疗支出超过170亿美元 每年一次。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)远程医疗的出现成为儿科ARI的一种护理选择。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就诊量的增加和更多不必要的抗生素使用有关。使用 DTC远程医疗的新选项，父母必须导航几个护理选项，每个选项都有潜力 质量领域相对于替代产品的得失。然而，人们对父母是如何 在总体感觉质量和DTC远程医疗之间进行权衡，特别是在以下情况下 做出关于ARI护理寻求的决定。这项提案的总体目标是解决这一关键问题 通过对儿科就医决策的全面理解来实现知识差距 ARIS在DTC远程医疗的背景下。在目标1中，我们将使用严格的决策科学方法来 确定父母在决定是否为孩子寻求照顾时所使用的“心理模式” 通过DTC远程医疗的ARI与其他选择。在目标2中，我们将采用稳健的量化方法。 确定与ARIS使用DTC远程医疗相关的患者、家庭和卫生系统因素 在全国商业索赔数据中，补充了我们对母公司决策的微观审查 用这种宏观层面的护理模式进行检查。在目标3中，我们将研究父母之间的权衡 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，要求父母在两种护理方式中进行选择 具有不同级别关键属性的选项(在目标1中确定)，允许确定首选项 以及全样本和不同使用DTC的分组的交易意愿阈值 ARIS的远程医疗(在目标2中确定)。该项目将把严谨的决策科学工具应用于 DTC远程医疗，在没有充分了解的情况下迅速被应用于儿科ARIS 它对就医决定的影响。综合起来，这些目标将提供对护理的批判性洞察- 在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 支持工具、干预设计和评估，以及与以下相关的支付方和决策者决策 儿童ARIS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.