Use of Telemedicine in the Treatment of Mental Illness

远程医疗在精神疾病治疗中的应用

• 批准号: 10442011
• 负责人: HAIDEN A. HUSKAMP
• 金额: $ 87.15万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10442011
• 关键词: Address; Aftercare; Area; Bipolar I; COVID-19; COVID-19 pandemic; Caring; Chronic; Clinical; Communities; Congresses; Data; Diffusion; Dimensions; Disadvantaged minority; Disease; Emergency department visit; Equipment and supply inventories; Face; Family member; Federal Government; Foundations; Future; Growth; Health Policy; Hospitalization; Improve Access; Individual; Insurance; Insurance Carriers; Insurance Claim Review; Interview; Laws; Licensure; Major Depressive Disorder; Measures; Medicaid; Medicare; Medicare/Medicaid; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; National Institute of Mental Health; Outcome; Paper; Patients; Pattern; Patterns of Care; Perception; Persons; Play; Policies; Privatization; Provider; Publishing; Quality of Care; Recording of previous events; Regulation; Role; Rural; Rural Community; Severities; Specialist; State Government; Technology; Telemedicine; Telemental; Telephone; Variant; Visit; Work; barrier to care; base; clinical care; clinical practice; digital; disadvantaged population; experience; health care delivery; health care disparity; health plan; health practice; improved; innovation; insurance claims; interest; long-standing disparities; machine learning method; medication compliance; minority patient; pandemic disease; parity; payment; programs; public health emergency; response; rural area; rural disparities; rural patients; telehealth; treatment disparity; underserved community; uptake

PROJECT SUMMARY Access to mental health specialists is limited for many patients in the U.S., particularly for those who live in rural or other underserved communities. Telemental health is one potential solution for this access problem. Prior to the COVID-19 pandemic, use of telemental health was growing in rural communities, but overall use was still low. During the public health emergency (PHE), use of telemental health increased dramatically across the U.S., and telemedicine currently accounts for the majority of mental health visits. Now that most clinicians and patients in treatment have tried telemental health, it is unclear how they will choose to incorporate this technology into clinical care after the PHE ends. In this renewal we seek to understand the future role of telemental health in mental health treatment and its relationship to access, equity, and quality of care. In the first four years of our mixed-method R01, we made substantial progress in understanding how telemental health is being used in real-world settings. We described its growth, how use varied substantially across communities, and whether it had reduced urban-rural disparities in care pre-COVID-19. In the last year, we pivoted to understanding the role that telemental health has played during the PHE and we worked directly with health plans, state government, and the federal government to inform policy decisions. Building off this foundation, we seek a renewal of our RO1 to understand how use of telemental health changes mental health practice after the PHE ends and the association of these new practice models and quality of care. Under the first aim, we seek to inform ongoing policy debates on reimbursement, licensure, and regulations by measuring differences in telemental health use in response to post-PHE changes in regulation and reimbursement. There has been considerable debate on whether telemental health will increase or decrease disparities in care. In the second aim, using both quantitative and qualitative analyses, we will assess the role of telemental health in care for disadvantaged populations and what is being done to address disparities. Under the third aim, we will explore how telemedicine has changed how clinicians treat major depression and bipolar-I disorder, illnesses representing different (on average) severity and chronicity, and, in the fourth aim, whether different telemental health patterns are associated with improved or worse outcomes. We will use a mixed methods approach that incorporates into each aim both quantitative analyses of Medicare, Medicaid, and commercial insurance claims data and qualitative interviews (either of providers or patients). Understanding how telemental health is incorporated into mental health treatment after the PHE, whether its use worsens or narrows existing disparities in care, the role of regulation and reimbursement in telemental health use, and whether different patterns of use are associated with higher quality care will help influence the ongoing policy debate on telemental health. Together the results of these aims are consistent with the NIMH’s expressed interest in innovative delivery models that can improve care for underserved communities.

项目总结 对于美国的许多患者来说，寻求心理健康专家的机会有限，特别是对于那些生活在 农村或其他服务不足的社区。远程健康是解决这一接入问题的一个潜在解决方案。 在新冠肺炎大流行之前，远程保健的使用在农村社区不断增长，但总体使用 仍然很低。在突发公共卫生事件(PHE)期间，远程保健的使用率在全国范围内大幅增加 在美国，远程医疗目前占心理健康就诊的大部分。现在大多数临床医生 正在接受治疗的患者已经尝试了远程健康，目前还不清楚他们将如何选择将其纳入 在PHE结束后将技术应用于临床护理。在这次更新中，我们试图了解 心理健康治疗中的远程健康及其与可获得性、公平和护理质量的关系。 在我们的混合方法R01的前四年中，我们在理解如何 远程健康正被用于现实世界的环境中。我们描述了它的发展，它的用途有很大的不同 跨社区，以及它是否缩小了新冠肺炎之前的城乡护理差距。去年， 我们转而了解远程健康在PHE期间所起的作用，我们直接工作 与医疗计划、州政府和联邦政府一起为政策决策提供信息。在此基础上构建 基金会，我们寻求更新我们的RO1，以了解远程健康的使用如何改变心理健康 PHE结束后的实践以及这些新的实践模式和护理质量的关联。在.之下 第一个目标是，我们寻求通过以下措施为正在进行的关于报销、许可和法规的政策辩论提供信息 针对PHE后管理和报销变化的远程健康使用的差异。那里 关于远程保健是否会增加或减少护理方面的差距，一直存在相当大的争论。在 第二个目标，使用定量和定性分析，我们将评估远程保健在保健中的作用 对于弱势群体，以及正在做些什么来解决差距问题。在第三个目标下，我们将 探索远程医疗如何改变临床医生治疗重度抑郁症和双相情感障碍的方式 代表不同的(平均)严重性和慢性病，在第四个目标中，是否有不同的智力因素 健康模式与改善或恶化的结果有关。我们将使用混合方法方法，即 在每个目标中包含了对Medicare、Medicaid和商业保险索赔的量化分析 数据和定性访谈(无论是提供者还是患者)。 了解远程健康如何纳入PHE后的精神健康治疗，无论其 使用加剧或缩小了现有的医疗保健、监管的作用和远程医疗补偿方面的差距 健康使用，以及不同的使用模式是否与更高质量的护理相关，将有助于影响 正在进行的关于远程保健的政策辩论。总的来说，这些目标的结果与NIMH的结果是一致的 表达了对能够改善对服务不足社区的护理的创新提供模式的兴趣。