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，尤其是农村地区 和少数民族人口。对于慢性病患者来说，获得专科护理的机会有所改善 结果。然而，获得专家的帮助存在许多障碍，特别是对于农村和农村地区来说。 少数民族人口。远程医疗是解决访问和医疗问题的潜在解决方案 全球范围内远程医疗在临床护理中的应用不断增加。阿拉斯加曾经是 远程医疗创新的领导者。最近，利用远程医疗视频电话会议 (VTC) 在阿拉斯加的慢性病专科护理领域大幅扩张。很少有研究 已评估与在护理中使用远程医疗 VTC 相关的结果或成本 慢性疾病。该提案的目的是评估远程医疗的影响 慢性病结果和费用的专业护理。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 特点； 2）探讨远程医疗VTC护理与临床的关系 慢性病的结果； 3) 对远程医疗 VTC 和现场医疗进行成本比较 因慢性病专科护理而就诊的人。第一个目标将通过混合来实现 方法方法。第一个目标的定量数据将用于倾向评分 目标 2 和 3 中的案例和对照相匹配。替代分析将包括工具分析 目标 2 和 3 的变量分析以及目标 3 的差异法。所有人的数据 目标将从多种来源获得，包括行政数据、定量数据 患者报告数据、定性患者报告数据、病历摘要、定量 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 关于使用远程医疗治疗慢性病的结果和成本的文献 关心。提供证据使医疗保健更安全与 AHRQ 的使命相关， 更高质量、更容易获得、公平且负担得起，并且与优先事项特别相关 重点领域是提高医疗保健的可负担性、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.