Provision of high quality telemental health care during COVID-19 and beyond

在 COVID-19 期间及之后提供高质量的远程医疗保健

• 批准号: 10532428
• 负责人: Samantha L Connolly
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2027-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10532428
• 关键词: Academy; Address; Anxiety; Appointment; Attitude; COVID-19; COVID-19 pandemic; Caring; Clinic; Clinical; Clinical Services; Collaborations; Comparative Effectiveness Research; Complex; Data; Decision Making; Development; Diagnosis; Effectiveness; Ensure; Future; Goals; Health Services; Health Services Accessibility; Health Technology; Healthcare; Home; Hospitalization; Hybrids; Infection; Infection prevention; Interview; Leadership; Medication Management; Medicine; Mental Health; Mental Health Services; Mentors; Methodology; Methods; Modality; Outcome; Outpatients; Patient Care; Patient Preferences; Patients; Persons; Positioning Attribute; Process; Provider; Psychologist; Psychotherapy; Publishing; Quality of Care; Recording of previous events; Research; Research Personnel; Research Priority; Safety; Sampling; Scientist; Services; Site; Suicide prevention; Symptoms; System; Telemental; Telephone; Testing; Time; Training; Travel; Veterans; Videoconferencing; Work; authority; base; caregiving; comparative effectiveness; connected care; coronavirus disease; cost; design; effectiveness implementation study; effectiveness implementation trial; effectiveness trial; evidence base; experience; health care delivery; hospitalization rates; implementation strategy; improved; infection risk; innovation; pandemic disease; preference; prevent; primary care services; social stigma; telehealth

Background: Telemental health (TMH) via videoconferencing or phone can increase Veterans’ access to mental health (MH) care. TMH can eliminate barriers including travel distance and cost, as well as physical limitations, caregiving responsibilities, and MH symptoms that can make leaving home difficult. Prior to COVID- 19, rates of TMH in VA were low (~9%). There was a dramatic shift towards TMH during COVID-19 to prevent infection, with ~50% of care delivered by phone, ~25% by video, and ~25% in-person. Benefits and drawbacks of phone, video, and in-person care must be considered when choosing a MH care modality. If patients, providers, and/or leadership believe that phone care is equivalent in quality to video and/or in-person, they may be more likely to choose this modality as it often has the fewest barriers to use; however, based on limited evidence, phone care may be lower quality than video and in-person. We need more nuanced analyses regarding: 1) the relative quality of phone, video, and in-person care (e.g., for more complex patients, for psychotherapy sessions versus shorter medication management appointments), and 2) patient preferences. As a clinical psychologist and HSR&D investigator with TMH experience, I am well-positioned to conduct this research. This proposal will provide key methodological training and advance me toward my goal of becoming a leading health services researcher and implementation scientist with expertise in telehealth. Significance/Impact: MH, telehealth, access, and quality of care are all major HSR&D research priorities. The increased use of TMH during COVID-19 has led to a wealth of untapped data through which we can examine the relative quality of TMH care as well as patient preferences across modalities, in order to improve care modality decision-making processes. Results, which will incorporate data from millions of patients and thousands of providers, have the potential to impact delivery of high-quality MH care on a national scale. Innovation: To our knowledge, there has been no published research that: 1) compares the quality and patient preference of phone, video, and in-person MH care, and 2) uses this information to develop and implement evidenced-based strategies to increase video use when clinically effective and preferred by patients. Specific Aims: Aim 1: Examine quality outcomes of phone, video, and in-person MH care (e.g., differences in MH hospitalization rates). Hypothesis: Video care will be equivalent to in-person care and superior to phone care for more complex patients (e.g., history of MH hospitalization, 3+ MH diagnoses) and for psychotherapy appointments. Aim 2: Qualitative interviews with MH patients, providers, and leadership. Research question: What are facilitators/barriers to video use based on stakeholder attitudes, preferences, and decision-making processes, and how do these factors vary between sites with high levels of phone, video, and in-person care? Aim 3: Develop/pilot implementation strategies to increase video use in circumstances where it is clinically effective and preferred by patients. Hypothesis: Implementation strategies will increase video use. Methodology: In Aim 1, I will test for differences in quality outcomes between modalities via a sample of ~2 million Veterans who received MH care between 3/2020-3/2021 using comparative effectiveness research strategies. In Aim 2, I will conduct interviews with key stakeholders to understand facilitators and barriers to video use based on attitudes, preferences and current decision-making processes. In Aim 3, I will synthesize Aim 1 and 2 findings to develop and pilot implementation strategies at one VISN 1 MH site to increase video use in circumstances where it is clinically effective and preferred by patients. Strategies will be targeted at the patient, provider, and/or system levels based on Aim 1 and 2 findings. Next Steps/Implementation: The piloted strategies will be spread to additional MH sites, and ultimately other clinical services, via hybrid implementation-effectiveness trials in subsequent IIRs. Findings will be communicated to MH and Connected Care operational partners to inform the future of VA MH care delivery.

背景：通过视频会议或电话进行的基本健康（TMH）可以增加退伍军人获得 心理健康（MH）护理。TMH可以消除旅行距离、成本以及物理等障碍 限制，负担的责任，和MH症状，可以使离开家困难。在COVID- 19，VA的TMH率较低（~9%）。在COVID-19期间，TMH发生了戏剧性的转变， 感染，约50%的护理通过电话提供，约25%通过视频提供，约25%亲自提供。优点和缺点 在选择MH护理模式时，必须考虑电话，视频和亲自护理。如果病人， 提供者和/或领导层认为电话护理的质量与视频和/或面对面护理相当，他们可能 更有可能选择这种方式，因为它通常具有最少的障碍使用;然而，基于有限的 证据表明，电话护理的质量可能低于视频和亲自护理。我们需要更细致的分析 关于：1）电话、视频和亲自护理的相对质量（例如，对于更复杂的患者， 心理治疗疗程与较短的药物管理预约），以及2）患者偏好。作为 作为一名临床心理学家和具有TMH经验的HSR&D调查员，我完全有能力进行这项工作 research.这个建议将提供关键的方法论培训，并推动我朝着我的目标，成为 一位领先的医疗服务研究人员和实施科学家，拥有远程医疗方面的专业知识。 意义/影响：MH，远程医疗，访问和护理质量都是主要的HSR&D研究重点。的 在COVID-19期间，TMH的使用增加，导致了大量未开发的数据，通过这些数据，我们可以检查 TMH护理的相对质量以及患者对不同模式的偏好，以改善护理 方式决策过程。结果，这将包括来自数百万患者的数据， 成千上万的提供者，有可能影响在全国范围内提供高质量的MH护理。 创新：据我们所知，还没有发表的研究：1）比较质量和患者 电话，视频和亲自MH护理的偏好，以及2）使用这些信息来开发和实施 基于证据的策略，以增加视频使用时，临床有效，患者的首选。 具体目标：目标1：检查电话、视频和面对面MH护理的质量结果（例如，差异 MH住院率）。假设：视频护理将等同于亲自护理，上级电话 护理更复杂的患者（例如，MH住院史，3+ MH诊断）和心理治疗 约会.目的2：定性访谈MH患者，供应商和领导。研究问题： 根据利益相关者的态度、偏好和决策，视频使用的促进因素/障碍是什么 这些因素在电话、视频和亲自护理水平较高的站点之间有何不同？ 目标3：制定/试行实施战略，以增加视频在临床上 效果好，深受患者喜爱。假设：实施策略将增加视频使用。 方法学：在目标1中，我将通过约2个样本来测试不同模式之间的质量结果差异 使用比较有效性研究在3/2020-3/2021之间接受MH护理的百万退伍军人 战略布局在目标2中，我将与主要利益相关者进行访谈，以了解促进因素和障碍， 基于态度、偏好和当前决策过程的视频使用。在目标3中，我将合成 目标1和2调查结果，在一个VISN 1 MH站点制定和试行实施战略，以增加视频 在临床有效且患者首选的情况下使用。战略将针对 基于目标1和目标2的结果的患者、提供者和/或系统级别。 后续步骤/实施：试点战略将推广到更多的MH站点，并最终推广到其他 临床服务，通过混合实施效果试验在随后的IIRs。数据的日期及时间为 传达给MH和Connected Care运营合作伙伴，以告知VA MH护理交付的未来。