Use of Telemedicine in the Treatment of Mental Illness

项目摘要 在美国，许多患者接触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。基本保健是解决这一获取问题的一个潜在办法。 在COVID-19大流行之前，远程医疗的使用在农村社区不断增长，但总体使用情况 仍然很低。在公共卫生紧急事件（PHE）期间，远程医疗的使用在全国范围内急剧增加。 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了远程健康，目前还不清楚他们将如何选择将其纳入其中。 在PHE结束后，将技术应用于临床护理。在这次更新中，我们寻求了解未来的作用， 心理健康治疗中的远程健康及其与获得，公平和护理质量的关系。 在我们的混合方法R 01的前四年中，我们在理解如何 远程健康正在现实世界中使用。我们描述了它的发展， 以及它是否减少了COVID-19前的城乡护理差异。去年， 我们转向理解远程健康在PHE期间所扮演的角色， 与健康计划、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，我们寻求更新我们的RO 1，以了解如何使用远程健康改变心理健康 PHE结束后的实践以及这些新实践模式与护理质量的关联。下 第一个目标是，我们通过测量， 远程医疗使用的差异，以应对后PHE的变化，在监管和报销。那里 关于远程健康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，我们将评估远程健康在护理中的作用 以及为解决差距正在采取的措施。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I型障碍的方式， 代表不同的（平均）严重程度和慢性程度，以及在第四个目标中，是否不同的远程 健康模式与结果的改善或恶化有关。我们将使用混合方法， 在每个目标中纳入了对医疗保险、医疗补助和商业保险索赔的定量分析 数据和定性访谈（提供者或患者）。 了解远程健康如何纳入PHE后的心理健康治疗，无论其 使用远程医疗可以减少或缩小现有的护理差距， 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 正在进行的远程健康政策辩论。这些目标的结果与NIMH的结果一致。 表示对创新的提供模式感兴趣，这些模式可以改善对服务不足社区的护理。

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.