Examining Telehealth Use in Skilled Nursing Facilities, with a Focus on Patients with Alzheimer's Disease and Related Dementias

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PROJECT SUMMARY/ABSTRACT CMS expanded telehealth coverage for Medicare beneficiaries in March 2020, removing multiple barriers to the provision of telehealth in skilled nursing facilities (SNFs). While telehealth has the potential to reduce potentially avoidable hospital readmissions and emergency department visits for patients in SNFs, there is very limited evidence on the impact of telehealth provision for Medicare beneficiaries in SNFs. Furthermore, although roughly 25% of Medicare beneficiaries in SNFs have a diagnosis of Alzheimer's disease and related dementias (ADRD), there is no population-level evidence on the impact of telehealth provision in SNFs for beneficiaries with ADRD. Although telehealth may improve access to necessary specialty care for patients with ADRD, there are numerous ADRD-specific barriers to telehealth use. The overall objectives for this proposal are to examine telehealth growth and the effect of telehealth provision on utilization, cost, and quality of care for Medicare beneficiaries with ADRD in SNFs and for beneficiaries generally in SNFs, and to examine facilitators of telehealth provision in SNFs. Through the proposed training plan, which includes a combination of formal coursework, workshops, and clinical rotations, as well as a multi-disciplinary mentorship team of NIH-funded investigators, the applicant will gain clinical knowledge on the treatment of PAC patients, with a focus on patients with ADRD, expertise in qualitative and mixed methods, and an understanding of telehealth implementation. Dr. Yu will use the methods and content knowledge gained through these training activities to achieve the following specific aims: (1) Examine the patterns of telehealth use for all SNF patients and for SNF patients with ADRD before and after the expansion of Medicare coverage, and assess the relative change in SNF telehealth and in-person visits; (2) Estimate the relationship between SNF telehealth provision and utilization, cost, and quality of care for all SNF patients and for SNF patients with ADRD; and (3) Identify SNF characteristics associated with telehealth provision, factors supporting or hindering telehealth provision in SNFs, and telehealth tools and technologies for patients with ADRD. This application is innovative because it leverages a quasi-experimental approach to estimate the causal effect of telehealth use, as well as a mixed methods approach to provide nuanced insights into telehealth provision in SNFs, including current and emerging uses of telehealth in SNFs for patients with ADRD. The proposed research is significant because it will provide new, critical evidence on the impact of telehealth use for SNF patients, with a focus on patients with ADRD and on how telehealth is provided to patients with ADRD, which may inform telehealth coverage policies and targeting of telehealth investments in PAC. This K01 investigator patients Award will provide Dr. Yu with the training and mentoring needed to become an R01-funded independent leading a research program on telehealth use for older adults in PAC settings, with a focus on with ADRD.