Mitigating effects of telehealth uptake on disparities in maternal care access, quality, outcomes, and expenditures during the COVID-19 pandemic

减轻 COVID-19 大流行期间远程医疗的采用对孕产妇护理获取、质量、结果和支出差异的影响

• 批准号: 10523364
• 负责人: Peiyin Hung
• 金额: $ 61.28万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10523364
• 关键词: Address; Adopted; Advocate; American; Bayesian Analysis; Big Data; Birth; Black Populations; Black race; COVID-19; COVID-19 impact; COVID-19 mortality; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Clinical; Communication; Community Surveys; Complement; Coronavirus; Cost Savings; Costs and Benefits; Data; Data Reporting; Databases; Death Certificates; Death Rate; Development; Discipline of obstetrics; Economics; Electronic Health Record; Electronic Mail; Epidemiologist; Ethnic Origin; Evidence based practice; Expenditure; Financial Hardship; Florida; Fright; Future; Geography; Goals; Health; Health Insurance; Health Policy; Health Services Accessibility; Healthcare Systems; Hispanic; Hispanic Populations; Hybrids; Income; Infant Health; Internet; Interruption; Location; Machine Learning; Maternal Health; Maternal Health Services; Measures; Medicaid; Methods; Minority; Minority Women; Outcome; Patient Self-Report; Patients; Perinatal; Persons; Policies; Population; Predisposition; Pregnant Women; Provider; Psychologist; Psychosocial Stress; Quality of Care; Race; Regulation; Relaxation; Research; Research Personnel; Resources; Role; Rural; Rural Community; Rural Health; Rural Hospitals; Rural Minority; Rural Population; SARS-CoV-2 infection; Security; Services; Site; South Carolina; Statutes and Laws; Testing; Transportation; Travel; Unemployment; United States; Urban Population; Visual; Woman; asynchronous encounter; behavioral health; clinical decision support; clinical decision-making; cohort; coronavirus disease; cost; data harmonization; data modeling; data sharing; disparity reduction; experience; gaps in access; health care economics; health care quality; health disparity; infant outcome; infection risk; innovation; maternal outcome; models and simulation; multidisciplinary; pandemic disease; population based; postpartum care; pregnant; prenatal; public health emergency; racial and ethnic; racial and ethnic disparities; remote patient monitoring; scale up; simulation; social; synchronous contact; telehealth; transportation access; trend; uptake; urban residence; waiver; women of color

Project Summary The Coronavirus disease 2019 (COVID-19) pandemic has caused significant social, healthcare, and economic devastation in the United States (US), potentially exacerbating the maternal health disparities facing rural women and women of color. Telehealth represents a promising opportunity to reducing disparities in maternal health access, quality, and outcomes, given its substantial range of opportunities, including audiovisual synchronous and asynchronous encounters between patients and providers, remote patient monitoring, facilitating visual communication of evidence-based practice, and supporting clinical decision-making. Yet, multilevel barriers might hinder some underserved women from fully benefiting from telehealth. Expanded federal and state-level telehealth coverage through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and state policies may be mitigating the detrimental effects of this unprecedented pandemic by reducing gaps in access to telehealth and quality maternity care. Although self-reported data indicated abrupt increases in telehealth uptake during the pandemic, limited real-world data are available regarding the role of perinatal telehealth uptake on the pandemic’s effects and the role of state level policy in telehealth adaptation during COVID-19. This longitudinal, real-world data study will use recurring national electronic health records (EHR) data [National COVID Cohort Collaborative (N3C)] and integrated statewide population-based data in South Carolina and Florida which complement the overrepresentation of urban populations in N3C. With multiple innovative approaches using common data modeling, multi-level imputation for missingness, and Bayesian statistics simulation methods, this study aims to: 1) investigate the impact of the COVID-19 pandemic on maternal care access, quality, and maternal and birth outcomes by maternal race/ethnicity and rural/urban residence; 2) examine whether perinatal telehealth uptake mitigates the pandemic's effects on disparities in maternal care access, quality, and outcomes by maternal race/ethnicity and rural/urban residence; and 3) assess how state-level telehealth policies (relaxation for originating sites, reimbursements for store-and- forward services, remote patient monitoring, and provider expansion) – relate to perinatal telehealth uptake by race-ethnicity and rural/urban residence. We will also 4) develop a stochastic simulation model to predict long-term changes in maternal care access, quality, outcomes, and expenditures of maternity care, with and without each respective state telehealth policy. Our overarching goal is to advance the understanding of the three-way intersections among the COVID-19 pandemic, state telehealth policy, and perinatal telehealth uptake on health disparities facing vulnerable maternal populations – rural and racial/ethnic minority women. We have formed a multidisciplinary team of investigators, including maternal health services researchers, health policy analysts, telehealth experts, senior clinical researchers, perinatal epidemiologists, rural health advocates, health psychologist, big data analysts, and machine learning experts to conduct this study.

项目摘要 2019年冠状病毒病（COVID-19）大流行造成了重大的社会，医疗保健和经济问题。 在美国（US）的破坏，可能会加剧农村面临的孕产妇健康差距 女性和有色人种女性。远程保健是减少孕产妇保健不平等的一个有希望的机会。 卫生服务的可及性、质量和成果，因为其机会范围很广，包括视听 患者和提供者之间的同步和异步接触，远程患者监测， 促进循证实践的视觉交流，并支持临床决策。然而， 多层次的障碍可能会阻碍一些得不到充分服务的妇女充分受益于远程保健。扩大 通过冠状病毒援助、救济和经济安全计划覆盖联邦和州级远程医疗 （关怀）法案和国家政策可能会减轻这一前所未有的大流行病的有害影响， 缩小在获得远程保健和优质孕产妇护理方面的差距。尽管自我报告的数据显示， 在大流行期间，远程保健的使用有所增加，但关于远程保健的作用， 围产期远程保健对大流行病的影响以及国家一级政策在远程保健适应中的作用 在COVID-19这项纵向、真实数据研究将使用重复出现的国家电子健康记录 (EHR)数据[国家COVID队列协作（N3 C）]和整合全州基于人口的数据， 南卡罗来纳州和佛罗里达补充了N3 C中城市人口的过度代表性。与 使用通用数据建模的多种创新方法，对缺失进行多级插补，以及 贝叶斯统计模拟方法，本研究旨在：1）调查COVID-19大流行的影响 按产妇种族/族裔和农村/城市分列的产妇保健获得情况、质量以及产妇和分娩结果 2）研究围产期远程保健的采用是否减轻了大流行病对居住地差异的影响， 按产妇种族/民族和农村/城市居住地分列的产妇护理获得、质量和结果;以及3） 评估州一级的远程医疗政策（放松始发站点，报销商店和 前向服务、远程患者监测和提供者扩展）-与围产期远程保健的采用有关， 种族-民族和农村/城市居住。我们还将开发一个随机模拟模型来预测 孕产妇保健的获得、质量、结果和支出的长期变化， 没有各自的远程医疗政策。我们的首要目标是促进对 COVID-19大流行、州远程医疗政策和围产期远程医疗普及率之间的三方交叉点 弱势孕产妇群体----农村和少数种族/族裔妇女----面临的健康差距。我们 成立了一个多学科的调查小组，其中包括产妇保健服务研究人员、卫生和 政策分析师、远程保健专家、高级临床研究人员、围产期流行病学家、农村健康倡导者， 健康心理学家、大数据分析师和机器学习专家来进行这项研究。