Health Services Utilization During the COVID-19 Pandemic

COVID-19 大流行期间卫生服务的利用

• 批准号: 10446307
• 负责人: Christopher Whaley
• 金额: $ 48.15万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10446307
• 关键词: Adopted; Adoption; Affect; Businesses; COVID-19; COVID-19 disparity; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 patient; COVID-19 vaccination; Cantor; Caring; Centers of Research Excellence; Characteristics; Clinical; Continuity of Patient Care; County; Data; Data Set; Elderly; Ensure; Face; Fee-for-Service Plans; Financial Hardship; Financial Support; Funding; Health; Health Services; Health Services Accessibility; Health system; Healthcare Systems; Home; Lead; Low income; Measures; Medicare; Modality; Natural experiment; Operative Surgical Procedures; Organizational Change; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Patterns of Care; Performance; Persons; Physicians; Policies; Population; Positioning Attribute; Privatization; Procedures; Provider; Publishing; Quality of Care; Research Personnel; Resources; Risk Factors; Running; Rural; Services; Shock; Social Distance; System; Technology; Telemedicine; Travel; United States; United States Agency for Healthcare Research and Quality; United States Centers for Medicare and Medicaid Services; Variant; Visit; Work; care delivery; care outcomes; coronavirus disease; design; ethnic minority population; experience; health care delivery; health care disparity; health care service utilization; health service use; improved; medical vulnerability; multiple chronic conditions; organizational structure; pandemic disease; patient population; patient subsets; payment; provider adoption; public health emergency; racial and ethnic; racial minority; resilience; response; social; social vulnerability; telehealth

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic has created an unprecedented shock to the U.S. health care system and to care delivery for patients. As documented by the study team, the COVID-19 pandemic suddenly and dramatically changed health care utilization patterns, including a rapid escalation in use of telehealth services, an abrupt decline in in-person services, and a large volume of deferred services. It is unclear how these care patterns will evolve over the course of the pandemic (e.g., the degree to which deferred services will occur later, telehealth will substitute for in-person services, and new levels of telehealth services will be sustained), much less in the years following the COVID-19 pandemic, and how continuing care patterns will differ for socially and clinically vulnerable patient populations. Physician organizations (POs) face differing burdens in rapidly adopting telemedicine, and PO barriers to telemedicine adoption may be reflected in the outcomes of patients treated by these POs. The reduction in in-person care has placed financial stress on many POs, leading to concerns that many POs may go out of business or consolidate. The impacts of care reductions, the adoption of telemedicine as a new care delivery modality, and access to POs are likely to have larger effects among vulnerable patient populations, including lower-income, rural, and racial/ethnic minority populations, and patients with multiple chronic conditions. Understanding patient and provider responses to the COVID-19 public health crisis and the care patients receive, particularly those who are medically and socially vulnerable, is essential to inform immediate-term and longer-term policymaking intended to help the health delivery system respond to COVID- 19. We propose to conduct a set of analyses to 1) Estimate how health services have changed during the COVID-19 pandemic, the factors associated with changes in health service use, if health delayed care remains unmet once the COVID-19 pandemic subsides, how policy responses (social distancing policies and COVID- 19 vaccination) have impacted care delivery, and how these patterns differ for medically and socially vulnerable patient populations; 2) Asses PO barriers to adopting telemedicine and assess if PO adoption of telemedicine lessens adverse health outcomes, particularly among vulnerable patient populations; and 3) Examine if PO closure or consolidation due to COVID-19 leads to gaps in patient care continuity or access barriers among vulnerable patient populations. To do so, we will leverage the existing data assets and expertise of the RAND U19 Center of Excellence that the research team has built over the past 5 years. We will use 100% Medicare fee-for-service claims data. Findings from this study will help inform an array of immediate-term and longer-term policies and regulatory changes, including changes to payment policies, use of technology, financial assistance to providers to ensure their survival, and improving the ability of health systems to respond to how the COVID-19 pandemic has reshaped the US health care system.

项目摘要/摘要 新冠肺炎疫情对美国的医疗体系和医疗保健造成了前所未有的冲击 为病人送货。正如研究小组记录的那样，新冠肺炎大流行突然而戏剧性地 改变了医疗保健的利用模式，包括远程医疗服务的使用迅速升级，突然 面对面服务的减少，以及大量的延迟服务。目前还不清楚这些护理模式将如何 在大流行的过程中演变(例如，延迟服务将在多大程度上发生，远程医疗 将取代面对面服务，远程医疗服务将保持新的水平)，更不用说 新冠肺炎大流行后的几年，以及社会和临床的持续护理模式将如何不同 脆弱的患者群体。医生组织(POS)在快速采用时面临不同的负担 远程医疗和采用远程医疗的PO障碍可能反映在接受以下治疗的患者的结果中 这些位置。面对面护理的减少给许多POS带来了财务压力，导致人们担心 许多邮局可能会倒闭或整合。减少护理的影响，采用远程医疗 作为一种新的护理提供方式，获得POS可能会对脆弱患者产生更大的影响 人口，包括低收入、农村和种族/少数民族人口，以及患有多发性多发性硬化症的患者 慢性疾病。了解患者和提供者对新冠肺炎公共卫生危机的反应 患者，特别是那些在医学和社会上处于弱势的患者所接受的护理，是必要的，告知 旨在帮助卫生提供系统应对新冠肺炎的近期和长期决策-- 19.我们建议进行一系列分析，以1)估计医疗服务在 新冠肺炎大流行，与卫生服务使用变化相关的因素，如果卫生保健仍然延误 一旦新冠肺炎大流行平息，政策回应如何(社会疏远政策和CoVID- 接种疫苗)影响了护理服务的提供，以及这些模式在医疗和社会方面的不同之处 脆弱的患者群体；2)评估采用远程医疗的PO障碍，并评估PO是否采用 远程医疗减少不良健康后果，特别是在易受伤害的患者群体中；以及3) 检查由于新冠肺炎导致的PO关闭或整合是否导致患者护理连续性或准入方面的差距 易受伤害患者群体之间的障碍。为此，我们将利用现有数据资产和 研究团队在过去5年中建立的兰德U19卓越中心的专业知识。我们 将使用100%的联邦医疗保险服务收费索赔数据。这项研究的发现将有助于为一系列 近期和较长期的政策和监管变化，包括支付政策的变化，使用 技术，向提供者提供财政援助，以确保他们的生存，并提高保健能力 应对新冠肺炎疫情如何重塑美国医疗体系的系统。