Telemedicine Utilization and Impacts on Access Among Rural Medicare Beneficiaries

远程医疗的利用及其对农村医疗保险受益人获得服务的影响

• 批准号: 10322721
• 负责人: Krisda H Chaiyachati
• 金额: $ 16.99万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-15 至 2022-03-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10322721
• 关键词: Accident and Emergency department; Acute; Adoption; Adult; Age; Aging; American; Career Choice; Caring; Chronic; Chronic Disease; Clinical; Complement; Complex; Congestive Heart Failure; County; Data; Dementia; Development Plans; Diabetes Mellitus; Elderly; Emergency department visit; Environment; Fee-for-Service Plans; Foundations; Frequencies; Future; Geography; Geriatrics; Goals; Health; Health Personnel; Health Policy; Health Services; Health care facility; Healthcare; Home; Hospitalization; Improve Access; Institution; Insurance; International; Internist; Learning; Measures; Medical; Medicare; Medicare Part B; Mental disorders; Mentors; Mentorship; Outcome; Patients; Pennsylvania; Persons; Policies; Population; Primary Health Care; Provider; Randomized Controlled Trials; Regulation; Research; Research Design; Research Personnel; Research Training; Resources; Rural; Specialist; Techniques; Technology; Telemedicine; Time; Training; Transportation; Universities; Videoconferencing; Visit; Vulnerable Populations; Work; acute care; analytical method; beneficiary; care providers; career development; comorbidity; econometrics; experimental study; federal poverty level; follow-up; frailty; health care availability; health economics; improved; improved outcome; medical specialties; payment; rural Americans; rural area; rurality; sociodemographics; success

PROJECT SUMMARY / ABSTRACT Candidate: Krisda H. Chaiyachati, MD, MPH, MSHP is a general internist and early-stage health services investigator passionate about improving access to health care and health outcomes for vulnerable, older, rural adults. He seeks content expertise in aging research and training in health economics to transition him towards independence and catalyze his career path towards improving health care access for older adults. Research Context: Rural, older Americans are facing an acute access crisis as fewer primary care providers and specialists work in rural areas to care for an increasingly older, poorer, sicker population. Telemedicine has been proposed as one solution to help overcome access barriers, but whether it is achieving this wanted outcome is unknown. Within fee-for-service Medicare plans—the most common insurance for rural, older Americans—telemedicine has been growing 128% per year since 2004. Understanding whether rural, older Americans with limited access have used telemedicine, how these visits have altered access, and whether telemedicine use reduces emergency department visits or hospitalizations remain fundamental questions for policymakers and providers if telemedicine is going to be promoted as a valuable way to deliver health care. Specific Aims: (1) Measure the association between telemedicine use and barriers to in-person care: residing in a county with fewer providers, having geriatric conditions, or living below the federal poverty level; (2) measure whether initial specialty telemedicine visits were follow-up visits or first-time visits and the association between barriers to in-person care and the frequency of follow-up or first-time telemedicine visits; and (3) measure the association between telemedicine use and subsequent acute care visits (emergency departments or hospitalizations), particularly among patients with geriatric conditions. Research Plan: To accomplish these aims, Dr. Chaiyachati will learn and develop quasi-experimental, econometric techniques to empirically analyze a large administrative datafile containing 2010-2018 fee-for- service Medicare Part B enrollees combined with provider supply measures, patient sociodemographics, and geographic indicators (e.g., rurality, broadband access, and transportation). Career Development Plan: Dr. Chaiyachati will (1) concentrate his passion and perspective on the needs of older adults; (2) develop expertise in analytic methods used by health economists to study large administrative datafiles; and (3) develop expertise in how telemedicine is being used and its impact in real-world settings. Dr. Chaiyachati's career development will be supported by close mentorship from international experts in geriatrics, health economics, telemedicine, and health policy. Environment: The University of Pennsylvania offers the ideal environment for him to pursue this training, with well-established mentors dedicated to his success and it is a well-resourced, interdisciplinary institution with a track record of producing successful, world-renowned, independent, health services researchers in aging.

项目概要/摘要 候选人：Krisda H. Chaiyachati，医学博士、公共卫生硕士、MSHP，是一名普通内科医生和早期健康服务人员 研究者热衷于改善弱势群体、老年人、农村地区获得医疗保健的机会和健康结果 成年人。他寻求老龄化研究方面的内容专业知识和健康经济学培训，以帮助他过渡到 独立并促进他的职业道路，以改善老年人的医疗保健机会。 研究背景：随着初级保健提供者的减少，农村老年人正面临着严重的医疗危机 专家在农村地区工作，照顾日益老龄化、贫困化和病情加重的人口。远程医疗 已被提议作为一种帮助克服准入障碍的解决方案，但它是否能够实现这一目标 结果未知。按服务收费的医疗保险计划——农村、老年人最常见的保险 美国人——自 2004 年以来，远程医疗每年增长 128%。了解农村、老年人是否 访问权限有限的美国人使用了远程医疗，这些就诊如何改变了访问权限，以及是否 远程医疗的使用减少了急诊科就诊或住院治疗，这仍然是人们面临的基本问题 政策制定者和提供者是否将远程医疗作为一种提供医疗保健的有价值的方式进行推广。 具体目标：(1) 衡量远程医疗的使用与现场护理障碍之间的关联：居住 在提供者较少、患有老年疾病或生活在联邦贫困线以下的县； (2) 衡量最初的专业远程医疗就诊是后续就诊还是首次就诊以及关联 面对面护理的障碍与后续或首次远程医疗就诊的频率之间的关系；和（3） 衡量远程医疗的使用与随后的急症护理就诊之间的关联（急诊科 或住院），特别是老年患者。 研究计划：为了实现这些目标，Chaiyachati 博士将学习和开发准实验、 计量经济学技术对包含 2010-2018 年费用的大型行政数据文件进行实证分析 服务 Medicare B 部分参与者与提供者供应措施、患者社会人口统计数据以及 地理指标（例如农村、宽带接入和交通）。 职业发展计划： Chaiyachati 博士将 (1) 将他的热情和观点集中在以下人员的需求上： 老年人； (2) 发展卫生经济学家研究大型行政管理分析方法的专业知识 数据文件； (3) 发展远程医疗的使用方式及其对现实环境影响的专业知识。博士。 Chaiyachati 的职业发展将得到国际专家的密切指导 老年病学、卫生经济学、远程医疗和卫生政策。 环境：宾夕法尼亚大学为他接受培训提供了理想的环境， 知名导师致力于他的成功，这是一所资源充足的跨学科机构， 培养成功的、世界知名的、独立的老龄化健康服务研究人员的记录。

项目成果

Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs.

患者和临床医生对 COVID-19 远程监测计划的看法以及未来计划的经验教训。

• DOI: 10.21203/rs.3.rs-2234197/v1
• 发表时间: 2022
• 期刊: Research square
• 作者: Chaiyachati,Krisda;Shea,Judy;Ward,Michaela;Nelson,Maria;Ghosh,Medha;Reilly,Julianne;Kelly,Sheila;Chisholm,Deena;Barbati,Zoe;Hemmons,Jessica;Abdel-Rahman,Dina;Ebert,Jeffrey;Xiong,Ruiying;Snider,Christopher;Lee,Kathleen;Friedma
• 通讯作者: Friedma

Using design and innovation principles to reduce avoidable emergency department visits among employees of a large academic medical center.

• DOI: 10.1016/j.hjdsi.2020.100514
• 发表时间: 2021-03
• 期刊: Healthcare (Amsterdam, Netherlands)
• 作者: Chaiyachati KH;Mahraj K;Mrad CG;O'Malley CJ;Balasta M;Snider C;Huffenberger AM;Hanson CW 3rd;Mehta SJ;Asch DA
• 通讯作者: Asch DA

Practical alternative to hospitalization for emergency department patients (PATH): A feasibility study.

• DOI: 10.1016/j.hjdsi.2021.100545
• 发表时间: 2021-09
• 期刊: Healthcare (Amsterdam, Netherlands)
• 作者: Kilaru AS;Resnick D;Flynn D;Rangnekar A;Snyder M;Oyekanmi K;Fitzpatrick D;Meisel ZF;Asch DA;Chaiyachati KH
• 通讯作者: Chaiyachati KH