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

项目摘要摘要 新冠肺炎大流行的一个戏剧性的长期影响是视频和电话的广泛使用 常规初级保健中的远程医疗。大流行导致初级保健做法严重限制了面对面 就诊和转向远程医疗就诊，但随着时间的推移，这种护理方式作为一种选择与面对面一起使用 关爱一直在持续。这对500多万痴呆症患者来说尤其重要 (PWD)和他们的照顾者。为残疾患者提供高质量的初级保健需要解决复杂的临床、社会和 健康的行为维度。虽然这些维度中的一些可能通过远程医疗得到促进，但程度 残疾人使用远程医疗并从远程医疗中受益尚不清楚。一方面，远程医疗可能会导致 更及时的初级保健，因为这种方式使残障人士不必出差，这特别具有挑战性 对这群人来说。然而，在远程医疗期间，初级保健提供者(PCP)面临能力有限 评估运动和功能状态，失去交流的细微差别，以及可能降低的能力或 残疾人和照顾者分享信息的意愿。这种限制可能会导致较差的护理质量， 包括随后使用面对面护理(例如急诊科就诊)的可能性较高。评估使用哪种PWD 远程医疗以及访问方式(视频、电话、面对面)与结果(及时性)之间的关系 护理和后续利用模式)将揭示初级保健使用的好处和缺点 在残障人士的照顾下进行远程医疗。 我们提出了一种序贯混合方法研究，它将产生强有力的证据来描述哪些残障人士 使用远程医疗，以及使用远程医疗与结果之间的关系(及时性和后续 利用)，在初级保健环境中。我们将利用两个大型医疗系统的数据：Kaiser Permanente 加州北部(KPNC)-远程医疗的先驱-和加州大学旧金山分校健康-国家认可的痴呆症护理 提供商。我们将利用这些结果，并结合文献审查，邀请一个国家专家小组参与 集思广益的潜在战略，以适应远程医疗的使用，以更好地支持初级痴呆症护理 护理环境。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。最终， 我们的结果将直接为全国初级保健实践面临的有关正在进行的 对远程医疗的投资，以及如何以服务于日益增长的痴呆症人口的方式对其进行优化。

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.