Evaluation of Telemedicine for Chronic Disease Specialty Care

项目摘要/摘要： 慢性病对人口有重大影响，对农村地区的影响不成比例 和少数族裔人口。对于慢性病患者，获得专科护理的机会有所改善 结果。然而，获得专家的机会有许多障碍，特别是对农村和农村地区。 少数族裔人口。远程医疗是一种潜在的解决途径问题的解决方案 在全世界范围内，远程医疗在临床护理中的应用一直在增加。阿拉斯加一直是一个 远程医疗创新领域的领导者。最近，远程医疗视频会议的使用 职业训练局(VTC)在阿拉斯加大幅扩大了慢性病专科护理。很少有研究 评估了在护理中使用远程医疗VTC的结果或成本 慢性病。这项提议的目标是评估远程医疗的影响 关于慢性病结果和成本的专门护理。为了实现这一目标，我们 提出以下具体目标：1)通过以下方式确定接受护理的预测因素 针对慢性病的远程医疗VTC，包括患者、提供者、社区和疾病 2)探讨远程医疗职业病护理与临床的关系 慢性病的结果；以及3)进行远程医疗VTC和In-VTC的成本比较 专人看望慢性病专科护理。第一个目标将使用混合的 方法：研究方法。来自第一个目标的量化数据将用于倾向评分 目标2和3中病例和对照的匹配。替代分析将包括工具性分析 目标2和目标3的变量分析和目标3的差异方法 目标将从各种来源获得，包括行政数据、数量 患者报告数据、定性患者报告数据、病历摘要、量化 从提供者收集的数据，以及来自医疗保健系统和付款人来源的成本数据。数据 将被整合，以充分告知所有研究目标。这项研究将大大有助于 关于在慢性病中使用远程医疗的结果和成本的文献 关心。与AHRQ的使命相关的是提供证据以使卫生保健更安全， 质量更高、更容易获得、公平和负担得起、与优先事项具体相关 重点领域是提高卫生保健的可负担性、效率和成本透明度。

Project Summary/Abstract: Chronic diseases have a significant impact on the population, disproportionately affecting rural and minority populations. For patients with chronic diseases, access to specialist care improves outcomes. However, there are many barriers to access to specialists, especially for rural and minority populations. Telemedicine is a potential solution to the problem of access and the uptake of telemedicine for clinical care has been increasing worldwide. Alaska has been a leader in telemedicine innovation. Recently, the use of telemedicine video teleconference (VTC) has expanded dramatically in Alaska for chronic disease specialty care. Few studies have evaluated the outcomes or costs associated with the use of telemedicine VTC in the care of chronic diseases. The objective of this proposal is to evaluate the impact of telemedicine specialty care on chronic disease outcomes and costs. In order to achieve this objective, we propose the following specific aims: 1) determine the predictors of receiving care by telemedicine VTC for chronic disease, including patient, provider, community, and disease characteristics; 2) investigate the relationship between telemedicine VTC care and clinical outcomes of chronic diseases; and 3) perform a cost comparison of telemedicine VTC and in- person visits for chronic disease specialty care. The first aim will be achieved using a mixed methods approach. Quantitative data from the first aim will be used for propensity score matching of cases and controls in Aims 2 and 3. Alternative analyses will include instrumental variable analysis for Aims 2 and 3 and a difference in difference approach for Aim 3. Data for all aims will be obtained from a variety of sources, including administrative data, quantitative patient-reported data, qualitative patient-reported data, medical record abstraction, quantitative data collected from providers, and cost data from health care system and payer sources. Data will be integrated to fully inform all study aims. This study will contribute substantially to the literature on outcomes and costs associated with the use of telemedicine in chronic disease care. It is relevant to the mission of AHRQ to produce evidence to make health care safer, higher quality, more accessible, equitable and affordable, and specifically relevant to the priority area of focus on improving health care affordability, efficiency and cost transparency.