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.

项目概要 对于美国的许多患者来说，接触心理健康专家的机会有限，尤其是那些居住在美国的患者 农村或其他服务欠缺的社区。远程心理健康是解决这一访问问题的一种潜在解决方案。 在 COVID-19 大流行之前，农村社区远程心理健康的使用正在增长，但总体使用情况 仍然很低。在突发公共卫生事件 (PHE) 期间，远程心理健康的使用在各个地区急剧增加 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 接受治疗的患者已经尝试过远程心理健康，目前尚不清楚他们将如何选择将其纳入其中 公共卫生结束后将技术引入临床护理。在这次更新中，我们试图了解未来的作用 心理健康治疗中的远程心理健康及其与护理的可及性、公平性和质量的关系。 在我们的混合方法 R01 的前四年里，我们在理解如何 远程心理健康正在现实世界中得到应用。我们描述了它的增长以及使用情况的巨大变化 跨社区的情况，以及它是否减少了 COVID-19 之前的城乡护理差异。在去年， 我们致力于了解远程心理健康在公共卫生期间所发挥的作用，并且我们直接开展工作 与卫生计划、州政府和联邦政府一起为政策决策提供信息。以此为基础 基金会，我们寻求更新 RO1，以了解远程心理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实践模式和护理质量的关联。下 第一个目标是，我们力求通过测量来为正在进行的有关报销、许可和监管的政策辩论提供信息 由于公共卫生事件后监管和报销的变化，远程心理健康使用方面存在差异。那里 关于远程心理健康是否会增加还是减少护理方面的差异一直存在相当多的争论。在 第二个目标，通过定量和定性分析，我们将评估远程心理健康在护理中的作用 针对弱势群体以及正在采取哪些措施来解决不平等问题。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等疾病的方式 代表不同的（平均）严重性和长期性，并且在第四个目标中，是否存在不同的远程心理 健康模式与改善或恶化的结果相关。我们将使用混合方法 将医疗保险、医疗补助和商业保险索赔的定量分析纳入每个目标 数据和定性访谈（提供者或患者）。 了解如何将远程心理健康纳入公共卫生事件后的心理健康治疗中，无论是 使用加剧或缩小了远程精神护理、监管和报销方面的现有差距 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 关于远程心理健康的持续政策辩论。这些目标的结果与 NIMH 的目标一致 对能够改善服务欠缺社区护理的创新服务模式表示了兴趣。