The Use of Telemedicine in the Care of Nursing Home Residents with Alzheimer's Disease and Related Dementias During and After the COVID-19 Pandemic

远程医疗在疗养院阿尔茨海默病患者护理中的应用 新冠肺炎大流行期间和之后的痴呆 项目总结 新型冠状病毒病2019(新冠肺炎)大流行已摧毁养老院居民 在美国，近一半的人被诊断为阿尔茨海默氏症和其他相关痴呆症(ADRD)。限制 居民接触和扩大从医生和高级实践中获得急需的护理的安全途径 提供者，联邦医疗保险放弃了以前严格的限制，并暂时允许SNF广泛使用 远程医疗以获得对居民的护理。取消这些限制有助于促进快速采用 远程医疗在SNF中，从2019年10月至12月任何远程医疗服务的SNF账单的1%增加到4月的55% 2020年5月。 长期以来，远程医疗一直被认为是SNF的一种有前途但未得到充分利用的交付创新 解决医疗保健方面的两个主要差距。首先，SNF临床医生并不总是在现场，因此出现的医疗问题 在非工作时间通常通过将病人转移到急诊室来解决，通常是不必要的 部门。其次，由于经济和后勤方面的原因，SNF居民很难获得 专科护理，包括神经病学或精神病学等对ADRD患者至关重要的专科。有限的文学作品 这表明远程医疗可以弥合这两个护理差距，但需要更严格的证据。 2021年，了解针对弱势群体的SNF远程医疗的采用和临床影响 患有ADRD的老年人群体有了新的紧迫性。我们建议使用联邦医疗保险索赔，最低 数据集和一项关于实施SNF远程医疗的全国调查，以回答以下具体目标： 1)评估SNF在2020年采用远程医疗与医疗保健用途的患者层面的关联 患有和不患有ADRD的snf居民的临床结果(新冠肺炎和非新冠肺炎)。 2)使用基于组的轨迹模型来表征2020-2021年远程医疗使用的SNF级别模式(例如， 持续与非采用)和与不同轨迹相关联的SNF特征。 3)调查按目标2中测量的轨迹分层的国家SNF样本，以评估设施 领导对远程医疗使用和远程医疗实施战略的看法。 了解SNF如何使用远程医疗及其与临床结果的关联 对于告知联邦医疗保险和州医疗补助计划应该如何规范和促进远程医疗使用至关重要 以SNF表示。我们的发现也将有助于指导护理患有ADRD的SNF住院医生的临床 与远程医疗使用有关的影响及其在全国范围内的使用情况。

The Use of Telemedicine in the Care of Nursing Home Residents with Alzheimer's Disease and Related Dementias During and After the COVID-19 Pandemic PROJECT SUMMARY The novel coronavirus disease 2019 (COVID-19) pandemic has devastated nursing home residents in the US, nearly half of whom are diagnosed with Alzheimer's and other related dementias (ADRD). To limit resident exposure and expand safe access to desperately-needed care from physicians and advanced practice providers, Medicare dropped previously tight restrictions and temporarily allowed SNFs to broadly use telemedicine to obtain care for residents. Dropping these restrictions helped facilitate a rapid adoption of telemedicine in SNFs, from <1% of SNFs billing for any telemedicine services in Oct-Dec 2019 to 55% in Apr- May 2020. Telemedicine has long been regarded as a promising, but underused, delivery innovation for SNFs addressing two major gaps in care. First, SNF clinicians are not always onsite, so medical issues that present during off-hours are often addressed by transferring patients, often unnecessarily, to the emergency department. Second, due to both financial and logistic reasons it is very difficult for SNF residents to obtain specialty care, including specialties critical those with ADRD like neurology or psychiatry. A limited literature suggests that telemedicine can bridge both of these care gaps, but more rigorous evidence is needed. In 2021, understanding the adoption and clinical impact of SNF telemedicine for the vulnerable population of older adults with ADRD has new urgency. We propose to use Medicare claims, the Minimum Data Set and a national survey on SNF telemedicine implementation to answer the following specific aims: 1) Evaluate the patient-level association of SNF adoption of telemedicine in 2020 with health care use and clinical outcomes (COVID-19 and non-COVID-19) for SNF residents with and without ADRD. 2) Use group-based trajectory models to characterize 2020-2021 SNF-level patterns of telemedicine use (e.g., sustaining vs. de-adopting) and SNF characteristics associated with different trajectories. 3) Survey a national sample of SNFs, stratified by their trajectories measured in Aim 2, to assess facility leadership perceptions of telemedicine use and telemedicine implementation strategies. Understanding how SNFs have used telemedicine and its association with clinical outcomes is essential to inform how Medicare and state Medicaid programs should regulate and promote telemedicine use in SNFs. Our findings will also help guide clinicians who care for SNF residents with ADRD on the clinical impact associated with telemedicine use and how it is being used nationally.