Assessing the Long-term Impact of COVID-induced Telemedicine Expansion on Dementia Care

项目摘要 COVID-19大流行的一个显著长期影响是基于视频和电话的 远程医疗在常规初级保健中的应用。这场大流行导致初级保健做法严重限制了亲自 访问和转向远程医疗访问，但随着时间的推移，使用这种护理方式作为一种选择，同时在人 关怀一直在坚持。这对500多万痴呆症患者的影响尤其重大 (PWD)和他们的照顾者。高质量的PWD初级保健需要解决复杂的临床、社会和 健康的行为维度。虽然远程医疗可能会促进其中一些方面的发展， 残疾人使用和受益于远程医疗的程度尚不清楚。一方面，远程医疗可能导致 更及时的初级保健，因为这种方式使残疾人不必旅行，这是特别具有挑战性的 对于这个人口。然而，在远程医疗遇到，初级保健提供者（PCP）面临能力有限， 评估运动和功能状态，失去沟通的细微差别，并可能降低能力或 残疾人和照顾者愿意分享信息。这种限制可能导致护理质量下降， 包括随后使用亲自护理的更高可能性（例如，艾德访视）。评估哪些残疾人使用 远程医疗和访问方式（视频，电话，亲自）和结果（及时性）之间的关系 护理和随后的利用模式）将揭示初级保健使用的好处和缺点， 远程医疗在残疾人护理中的应用 我们提出了一个连续的混合方法研究，将产生强大的证据表征哪些残疾人 使用远程医疗，以及远程医疗的使用与结果（及时性和后续 （二）在基层医疗机构。我们将利用两个大型卫生系统的数据： 北方加利福尼亚州（KPNC）-远程医疗的先驱-和UCSF健康-国家认可的痴呆症护理 提供商我们将利用这些结果，以及文献综述，聘请一个国家专家小组， 集思广益潜在策略，以适应远程医疗的使用，以更好地支持初级痴呆症护理 护理设置。最后，我们将进行一项PCP调查，以评估这些战略的可行性和影响。最后， 我们的研究结果将直接告知全国各地的初级保健实践所面临的决策， 投资远程医疗，以及如何优化它，为不断增长的痴呆症人口服务。

Project Summary Abstract A dramatic long-term effect of the COVID-19 pandemic is the expanded use of video- and phone-based telemedicine in routine primary care. The pandemic caused primary care practices to severely limit in-person visits and shift to telemedicine visits, but over time use of this modality of care as an option alongside in-person care is persisting. The implications are particularly significant for the more than 5 million people with dementia (PWD) and their caregivers. High-quality primary care for PWD requires addressing complex clinical, social, and behavioral dimensions of health. While some of these dimensions may be facilitated by telemedicine, the degree to which PWDs use and benefit from telemedicine is unknown. On the one hand, telemedicine may result in more timely primary care as this modality allows PWD to avoid the need to travel, which is particularly challenging for this population. However, during telemedicine encounters, primary care providers (PCPs) face limited ability to assess movement and functional status, loss of communication nuances, and potentially reduced ability or willingness of PWD and caregivers to share information. Such limitations could result in poorer quality of care, including higher likelihood of subsequent utilization of in-person care (e.g., ED visits). Assessing which PWD use telemedicine and the relationships between visit modality (video, phone, in-person) and outcomes (timeliness of care and subsequent utilization patterns) will reveal the benefits and the shortcomings from primary care use of telemedicine in the care of PWD. We propose a sequential mixed-methods study that will generate robust evidence characterizing which PWDs use telemedicine, and the relationships between use of telemedicine and outcomes (timeliness and subsequent utilization), in the primary care setting. We will draw on data from two large health systems: Kaiser Permanente Northern CA (KPNC) - a telemedicine pioneer - and UCSF Health - a nationally-recognized dementia care provider. We will use these results, alongside a literature review, to engage a national expert panel in brainstorming potential strategies to adapt the use of telemedicine to better support dementia care in the primary care setting. Finally, we will conduct a PCP survey to rate the feasibility and impact of the strategies. Ultimately, our results will directly inform the decisions facing primary care practices across the nation about ongoing investment in telemedicine and how to optimize it in ways that serve the growing dementia population.