The Role of Virtual Care in Improving Primary Care Access and Continuity for At-Risk Multimorbid Older Adults

项目摘要/摘要 这项K23奖项将确立Ishani Ganguli医学博士、公共卫生硕士作为临床医生-研究员的地位，专注于 医疗服务提供和支付创新如何促进高价值门诊服务 老年人的结果。甘古利博士是医学和初级保健的助理教授 哈佛医学院和布里格姆妇女医院的内科医生。建立在她的基础上 研究护理创新和引领创新的临床培训、方法课程和经验 在责任关怀组织(ACO)，该奖项将允许她在(1)方面发展专业知识 老龄化的需要，特别是对于那些患有多发病和阿尔茨海默病(AD)和 AD相关痴呆(AD/ADRD)，可通过门诊护理创新来满足，(2)晚期 量化方法；(3)与索赔挂钩的电子健康记录(EHR)数据分析。至 为了实现这些目标，甘古利博士组建了一支拥有卫生服务专业知识的团队 医疗创新研究(Ateev Mehrotra博士、Thomas Sequist博士)、老年病学研究(Christine博士 Ritchie)、初级保健(Meredith Rosenthal博士、约书亚·梅特雷博士)、定量方法(Dr.E. 约翰·奥拉夫、J·迈克尔·麦克威廉姆斯、克雷格·波拉克)和电子病历数据分析(克里斯汀·沃格利博士)。 初级保健的可获得性和护理的连续性改善了多病老年人的预后，因此 最近初级保健办公室就诊率的下降-可能部分是由于参加这些 访问-引发了人们的担忧。虚拟护理可以实现可获得性和连续性。但我们不知道 在新冠肺炎大流行之前，哪些组织面临办公室访问障碍，也不知道后 虚拟护理的大流行扩大将影响这些群体获得初级保健的机会或连续性。 为了解决这些关键问题，甘古利博士将首先使用与索赔相关的Medicare Current 受益人调查，以描述与以下相关的访问使用和访问连续性护理(COC) 报告到达医生办公室有困难，以及患有AD/ADRD的成年人或有社会风险的人 造成这一障碍的因素风险更大(目标1)。在目标2中，使用差异中的差异 分析一家大型Medicare ACO中与索赔相关的EHR数据，她将评估 虚拟护理的大流行扩大影响了这些人群中初级保健的使用。在《目标3》中，她 将使用这些与索赔相关的EHR数据来开发COC措施的新应用 (“触摸连续性”，包括虚拟护理)，并确定它是否与 可预防的住院治疗。这项工作和培训将为未来的R01奠定基础 关于虚拟初级保健的准实验性、多卫生系统研究的建议 患有多病的老年人。本K23奖项和未来的R01将告知如何付款和交付 虚拟护理，促进高价值的门诊护理，为老年人提供更好的结果。

Project Summary/Abstract This K23 award will establish Ishani Ganguli MD, MPH as a clinician-investigator focused on how care delivery and payment innovation can advance high-value outpatient care and better outcomes for older adults. Dr. Ganguli is an Assistant Professor of Medicine and primary care physician at Harvard Medical School and Brigham and Women’s Hospital. Building on her clinical training, methods coursework, and experiences studying care innovation and leading it at an Accountable Care Organization (ACO), this award will allow her to develop expertise in (1) how aging needs, especially for those with multimorbidity and Alzheimer’s Disease (AD) and AD-related dementias (AD/ADRD), can be met through outpatient care innovation, (2) advanced quantitative methods, and (3) claims-linked electronic health record (EHR) data analysis. To achieve these goals, Dr. Ganguli has assembled a team with expertise in health services research on care innovation (Drs. Ateev Mehrotra, Thomas Sequist), geriatrics (Dr. Christine Ritchie), primary care (Drs. Meredith Rosenthal, Joshua Metlay), quantitative methods (Drs. E. John Orav, J. Michael McWilliams, Craig Pollack), and EHR data analysis (Dr. Christine Vogeli). Primary care access and continuity of care improve outcomes for multimorbid older adults, so a recent decline in primary care office visit rates – likely due in part to barriers attending these visits – raises concerns. Virtual care may enable access and continuity. But we do not know which groups faced office visit barriers pre-dating the Covid-19 pandemic nor how post- pandemic expansion of virtual care will affect primary care access or continuity for these groups. To address these critical questions, Dr. Ganguli will first use the claims-linked Medicare Current Beneficiary Survey to describe visit use and visit continuity of care (COC) associated with reported trouble getting to the doctor’s office and whether adults with AD/ADRD or social risk factors were at greater risk of this barrier (Aim 1). In Aim 2, using difference-in-differences analysis of claims-linked EHR data in a large Medicare ACO, she will assess how post- pandemic expansion of virtual care affects primary care use in these populations. In Aim 3, she will use these claims-linked EHR data to develop a novel application of the COC measure (“touch continuity,” which includes virtual care) and determine if it is associated with risk of preventable hospitalizations. This work and training will provide the basis for a future R01 proposal of a quasi-experimental, multi-health system study of virtual primary care for multimorbid older adults. This K23 award and future R01 will inform how to pay for and deliver virtual care to promote high-value outpatient care and better outcomes for older adults.