The Role of Virtual Care in Improving Primary Care Access and Continuity for At-Risk Multimorbid Older Adults

项目概要/摘要 这个K23奖将建立Ishani Ganguli MD，MPH作为临床研究者，专注于 护理提供和支付创新如何推动高价值门诊护理并提供更好的服务 老年人的结果。Ganguli博士是医学和初级保健助理教授 他是哈佛医学院和布里格姆妇女医院的医生。以她为基础 临床培训，方法课程，以及研究护理创新和领导它的经验 在一个负责任的护理组织（ACO），这个奖项将使她发展的专业知识（1） 如何衰老的需要，特别是对于那些患有多发性硬化症和阿尔茨海默病（AD）的人， AD相关痴呆（AD/ADRD），可以通过门诊护理创新来满足，（2）晚期 定量方法，和（3）索赔相关的电子健康记录（EHR）数据分析。到 为了实现这些目标，Ganguli博士组建了一个医疗服务专业团队， 护理创新研究（Ateev Mehrotra博士，托马斯Sequist），老年医学研究（克莉丝汀博士 里奇），初级保健（梅雷迪思罗森塔尔博士，约书亚梅特利），定量方法（E。 John Orav、J. Michael McWilliams、克雷格波拉克）和EHR数据分析（克莉丝汀沃格利博士）。 初级保健的获得和护理的连续性改善了多病老年人的结局， 最近初级保健办公室就诊率下降-部分原因可能是参加这些活动的障碍 访问-引起关注。虚拟护理可以实现访问和连续性。但我们不知道 在新冠肺炎大流行之前，哪些群体面临办公室访问障碍，以及在新冠肺炎大流行之后， 虚拟保健的大流行性扩展将影响这些群体获得初级保健的机会或连续性。 为了解决这些关键问题，Ganguli博士将首先使用与索赔相关的Medicare Current 受益人调查，描述与以下相关的就诊使用和就诊护理连续性（COC） 报告说，去医生办公室有困难，是否有AD/ADRD或社会风险的成年人 这些因素的风险更大（目标1）。在目标2中，使用差异中的差异 在一个大型的医疗保险ACO索赔相关的EHR数据分析，她将评估如何后， 虚拟保健的大流行性扩展影响了这些人群对初级保健的使用。在目标3中，她 我将使用这些与索赔相关的EHR数据来开发COC度量的新应用 （“触摸连续性”，包括虚拟护理），并确定它是否与风险相关， 可预防的住院治疗这项工作和培训将为未来的R 01提供基础 一项关于虚拟初级保健的准实验性多保健系统研究的建议， 多病老年人此K23奖励和未来的R 01将告知如何支付和交付 虚拟护理，以促进高价值的门诊护理和老年人更好的结果。

Project Summary/Abstract This K23 award will establish Ishani Ganguli MD, MPH as a clinician-investigator focused on how care delivery and payment innovation can advance high-value outpatient care and better outcomes for older adults. Dr. Ganguli is an Assistant Professor of Medicine and primary care physician at Harvard Medical School and Brigham and Women’s Hospital. Building on her clinical training, methods coursework, and experiences studying care innovation and leading it at an Accountable Care Organization (ACO), this award will allow her to develop expertise in (1) how aging needs, especially for those with multimorbidity and Alzheimer’s Disease (AD) and AD-related dementias (AD/ADRD), can be met through outpatient care innovation, (2) advanced quantitative methods, and (3) claims-linked electronic health record (EHR) data analysis. To achieve these goals, Dr. Ganguli has assembled a team with expertise in health services research on care innovation (Drs. Ateev Mehrotra, Thomas Sequist), geriatrics (Dr. Christine Ritchie), primary care (Drs. Meredith Rosenthal, Joshua Metlay), quantitative methods (Drs. E. John Orav, J. Michael McWilliams, Craig Pollack), and EHR data analysis (Dr. Christine Vogeli). Primary care access and continuity of care improve outcomes for multimorbid older adults, so a recent decline in primary care office visit rates – likely due in part to barriers attending these visits – raises concerns. Virtual care may enable access and continuity. But we do not know which groups faced office visit barriers pre-dating the Covid-19 pandemic nor how post- pandemic expansion of virtual care will affect primary care access or continuity for these groups. To address these critical questions, Dr. Ganguli will first use the claims-linked Medicare Current Beneficiary Survey to describe visit use and visit continuity of care (COC) associated with reported trouble getting to the doctor’s office and whether adults with AD/ADRD or social risk factors were at greater risk of this barrier (Aim 1). In Aim 2, using difference-in-differences analysis of claims-linked EHR data in a large Medicare ACO, she will assess how post- pandemic expansion of virtual care affects primary care use in these populations. In Aim 3, she will use these claims-linked EHR data to develop a novel application of the COC measure (“touch continuity,” which includes virtual care) and determine if it is associated with risk of preventable hospitalizations. This work and training will provide the basis for a future R01 proposal of a quasi-experimental, multi-health system study of virtual primary care for multimorbid older adults. This K23 award and future R01 will inform how to pay for and deliver virtual care to promote high-value outpatient care and better outcomes for older adults.