Transition to Telehealth for Mental Health Care in the Wake of COVID-19

项目摘要 美国对COVID-19的反应已经在精神疾病的远程医疗政策方面产生了变革性的转变。 医疗保健，包括扩大提供者报销、许可证可携带性和允许的远程医疗 平台在COVID-19的背景下，美国的心理健康在多大程度上仍然没有答案 医疗设施已过渡到远程保健，以及对获得保健的机会、公平性和质量的影响。我们提出了一个 远程医疗扩展对获得、公平和健康的影响的纵向、混合方法评价 和精神卫生保健的质量-根据提供者和病人的观点。 首先，使用秘密购物者方法，我们模拟试图访问 远程健康服务，全国有代表性的1,500个精神健康治疗设施的样本， 第1年和第2年，创建一个纵向存储库，记录服务可用性的演变， 远程医疗服务。其次，我们将生成一个独特的纵向次要数据集， 设施，县和州一级的特征，以调查预测远程医疗可用性的关键因素 沿着三个轴：（i）设施特征，如设施类型和设施管理结构;（ii） 县级社会经济、种族/民族和地理差异;以及（iii）州一级与COVID相关的 立法第三，在解释性顺序混合方法设计之后，我们将使用来自 秘密购物者调查，以指导与20家设施的供应商进行的关键知情人（KI）访谈-按 该设施是否提供远程医疗服务，以及这是否发生在COVID-19爆发后。KI 访谈将提供关键的见解提供者的观点障碍和促进远程保健，质量 护理，以及他们从患者那里得到的反馈。我们的三个具体目标是： 目标1：对1,500家精神卫生治疗机构进行纵向秘密购物者调查，以评估 在COVID-19大流行期间，患者在获得特定远程医疗服务方面遇到了一系列障碍。 目标2：建立一个综合设施、县和州一级特点的国家数据库， 检查2015-2022年远程医疗服务可用性的三组预测因素：（i）设施 特点-包括管理形式和接受的保险;（二）县级种族/族裔， 社会经济及地理组成;及（iii）州级COVID-19相关政策。 目标3：记录提供远程医疗服务的关键促进因素和障碍， 护理质量和患者的反馈，从KI与分层样本提供者的访谈中得出。 这项拟议中的研究将揭示快速变化的远程医疗服务格局- 包括在获得、公平和护理质量方面。在此基础上，我们将追求R 01， 我们将完整的数据集与索赔数据联系起来，以检查远程医疗利用率和患者相关结果。

Project Summary The response to COVID-19 in the U.S. has generated a transformative shift in telehealth policies for mental health care, including expansion of provider reimbursement, licensure portability, and permitted telehealth platforms. Against the backdrop of COVID-19, it remains unanswered to what extent U.S. mental health facilities have transitioned to telehealth, as well as effects on access, equity and quality of care. We propose a longitudinal, mixed-methods evaluation of the effects of telemental health expansion on access, equity and quality of mental health care—according to provider and patient perspectives. First, using a secret shopper approach, we simulate the patient experience of attempting to access telemental health services with a nationally representative sample of 1,500 mental health treatment facilities in Years 1 and 2, creating a longitudinal repository of the evolution of service availability for a wide array of telemental health services. Second, we will generate a unique, longitudinal secondary dataset that merges facility-, county- and state-level characteristics to investigate key factors that predict telehealth availability along three axes: (i) facility characteristics such as type of facility and facility management structure; (ii) county-level socioeconomic, racial/ethnic, and geographic disparities; and (iii) state-level COVID-related legislation. Third, following an explanatory sequential mixed-methods design, we will use responses from the secret shopper survey to guide key informant (KI) interviews with providers at 20 facilities—stratified by whether the facility offers telehealth services, and whether this occurred following onset of COVID-19. KI interviews will provide key insights on provider perspectives on barriers and facilitators to telehealth, quality of care, and feedback they have received from patients. Our three specific aims are: Aim 1: Conduct a longitudinal secret shopper survey of 1,500 mental health treatment facilities to assess an array of patient barriers to accessing specific telemental health services during the COVID-19 pandemic. Aim 2: Create a national database that synthesizes facility-, county-, and state-level characteristics to examine three sets of predictors of telemental health service availability from 2015-2022: (i) facility characteristics—including forms of management and accepted insurance; (ii) county-level racial/ethnic, socioeconomic, and geographic composition; and (iii) state-level COVID-19 related policies. Aim 3: Record key facilitators and barriers to offering telemental health services, provider perspectives on quality of care, and feedback from patients, drawing from KI interviews with a stratified sample of providers. The proposed study will shed light on the rapidly changing landscape of telemental health services— including with regard to access, equity and quality of care. Building from this, we will pursue an R01 in which we link our completed dataset to claims data to examine telehealth utilization and patient-related outcomes.