Evaluation of Telemedicine for Chronic Disease Specialty Care

项目概要/摘要： 慢性病对人口有重大影响，特别是农村人口 少数民族人口。对于慢性病患者，获得专科护理的机会有所改善 结果。然而，在获得专家服务方面存在许多障碍，特别是对农村和 少数族裔人口。远程医疗是一个潜在的解决办法， 全世界越来越多地采用远程医疗进行临床护理。阿拉斯加是一个 远程医疗创新的领导者。最近，远程医疗视频会议的使用 (VTC)在阿拉斯加州的慢性病专科护理方面有了显著的扩张。很少有研究 已经评估了与在护理中使用远程医疗VTC相关的结果或成本 慢性病的症状。这项建议的目的是评价远程医疗的影响 专科护理对慢性疾病的结果和成本。为了实现这一目标，我们 提出以下具体目标：1）确定接受护理的预测因素， 慢性病远程医疗VTC，包括患者、提供者、社区和疾病 特点; 2）调查远程医疗VTC护理与临床的关系 慢性疾病的结果;和3）进行远程医疗VTC和在成本比较- 慢性病专科护理的个人访问。第一个目标将使用混合 方法论。第一个目标的定量数据将用于倾向评分 目标2和3中病例和对照的匹配。替代分析将包括仪器分析 目标2和3的变量分析以及目标3的差异方法中的差异。Data for all 目标将从各种来源获得，包括行政数据，定量数据， 患者报告数据，定性患者报告数据，病历摘要，定量 从提供者收集的数据，以及从卫生保健系统和付款人来源收集的成本数据。数据 将被整合，以充分告知所有研究目标。这项研究将大大有助于 关于在慢性病中使用远程医疗的结果和费用的文献 在乎它与AHRQ的使命有关，即提供证据，使医疗保健更安全， 更高的质量，更容易获得，公平和负担得起的，特别是与优先事项有关的 重点领域是提高医疗保健的可负担性、效率和成本透明度。

Project Summary/Abstract: Chronic diseases have a significant impact on the population, disproportionately affecting rural and minority populations. For patients with chronic diseases, access to specialist care improves outcomes. However, there are many barriers to access to specialists, especially for rural and minority populations. Telemedicine is a potential solution to the problem of access and the uptake of telemedicine for clinical care has been increasing worldwide. Alaska has been a leader in telemedicine innovation. Recently, the use of telemedicine video teleconference (VTC) has expanded dramatically in Alaska for chronic disease specialty care. Few studies have evaluated the outcomes or costs associated with the use of telemedicine VTC in the care of chronic diseases. The objective of this proposal is to evaluate the impact of telemedicine specialty care on chronic disease outcomes and costs. In order to achieve this objective, we propose the following specific aims: 1) determine the predictors of receiving care by telemedicine VTC for chronic disease, including patient, provider, community, and disease characteristics; 2) investigate the relationship between telemedicine VTC care and clinical outcomes of chronic diseases; and 3) perform a cost comparison of telemedicine VTC and in- person visits for chronic disease specialty care. The first aim will be achieved using a mixed methods approach. Quantitative data from the first aim will be used for propensity score matching of cases and controls in Aims 2 and 3. Alternative analyses will include instrumental variable analysis for Aims 2 and 3 and a difference in difference approach for Aim 3. Data for all aims will be obtained from a variety of sources, including administrative data, quantitative patient-reported data, qualitative patient-reported data, medical record abstraction, quantitative data collected from providers, and cost data from health care system and payer sources. Data will be integrated to fully inform all study aims. This study will contribute substantially to the literature on outcomes and costs associated with the use of telemedicine in chronic disease care. It is relevant to the mission of AHRQ to produce evidence to make health care safer, higher quality, more accessible, equitable and affordable, and specifically relevant to the priority area of focus on improving health care affordability, efficiency and cost transparency.