Project 2: The Intersection of Telehealth and Health Disparities in At-Risk Older Patients with Cancer

项目 2：远程医疗与高危老年癌症患者健康差异的交叉点

• 批准号: 10762145
• 负责人: Melody K Schiaffino
• 金额: $ 24.45万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762145
• 关键词: Address; Adverse event; COVID-19 pandemic; California; Cancer Patient; Caring; Catchment Area; Cohort Studies; Communication; Complement; County; Data; Data Set; Databases; Development; Disparity; Elderly; Emergency department visit; Environment; Equity; Ethnic Origin; Future; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Household; Improve Access; Income; Individual; Inequality; Inequity; Internet; Intervention; Knowledge; Language; Link; Logistic Regressions; Low income; Malignant Neoplasms; Medicare; Medicare claim; Medicare/Medicaid; Methods; Modeling; Oncology; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Perception; Persons; Policies; Policy Maker; Population; Populations at Risk; Positioning Attribute; Provider; Quality of Care; Race; Research; Risk; Safety; Secondary to; Socioeconomic Status; Surveys; Technology; Telecommunications; Testing; Visit; Vulnerable Populations; access disparities; adverse outcome; anticancer research; beneficiary; cancer care; cancer education; cancer health disparity; cancer risk; care delivery; care outcomes; disparity reduction; ethnic minority; experience; health disparity; health equity; improved; interest; marginalized population; neoplasm registry; older patient; pandemic disease; patient population; patient-level barriers; population based; post-COVID-19; provider-level barriers; racial minority; response; telehealth

PROJECT SUMMARY/ ABSTRACT – PROJECT 2 Telehealth utilization increased rapidly across the US healthcare system in response to the COVID-19 pandemic. As we emerge from the pandemic, telehealth has become a new option for communication between patients and providers. Cancer care delivery appears well positioned to incorporate telehealth into the standard workflow of patient care. Furthermore, equitable implementation of telehealth could potentially increase access to care among vulnerable patients. However, emerging data suggest disparities with telehealth utilization access among non-White, low income, and non-English speaking individuals. Inequitable implementation of telehealth could inadvertently create barriers among our most vulnerable patients, which could paradoxically increase cancer health disparities. Large-scale rigorous research evaluating disparities in telehealth utilization within the post-COVID-19 cancer care environment is lacking. Furthermore, research has not addressed how telehealth utilization influences safety and quality of care compared to conventional in-person visits, particularly among our at-risk populations with higher baseline risks of poor outcomes and adverse events. Finally, a comprehensive understanding of telehealth disparities requires an understanding of patient perceptions and provider biases towards telehealth, which represent important unaddressed questions. To fill these critical knowledge gaps, we propose a comprehensive population-based cohort study among Medicare beneficiaries with cancer, incorporating linkages to secondary datasets providing data on providers, hospitals, and regional factors. We will assess the impact of telehealth on vulnerable cancer populations through the following aims: 1) identify and characterize disparities in telehealth during and after the COVID-19 pandemic; 2) assess the impact of telehealth on efficacy and safety of cancer delivery among at-risk populations; and 3) define actionable patient-level barriers and provider biases with telehealth utilization. This proposed study will help define the national landscape of telehealth among cancer patients, and will provide a framework for the development of future interventions to optimize telehealth among at-risk patients. This timely project will deliver actionable information to providers, healthcare systems, and policymakers. Overall, equitable, safe, and effective telehealth delivery stands to increase access to care and reduce cancer health disparities among our most vulnerable cancer patients.

项目摘要/摘要 – 项目 2 为应对 COVID-19，美国医疗保健系统中的远程医疗利用率迅速增加 大流行。随着我们摆脱大流行，远程医疗已成为人们之间沟通的新选择 患者和提供者。癌症护理服务似乎处于有利位置，可以将远程医疗纳入标准 患者护理的工作流程。此外，公平实施远程医疗可能会增加获取机会 照顾弱势患者。然而，新出现的数据表明远程医疗利用率存在差异 非白人、低收入和非英语人士的访问。执行不公平 远程医疗可能会无意中在我们最脆弱的患者中制造障碍，这可能会自相矛盾 增加癌症健康差异。评估远程医疗利用差异的大规模严格研究 COVID-19 后的癌症护理环境缺乏。此外，研究尚未解决如何 与传统的亲自就诊相比，远程医疗的使用会影响护理的安全性和质量，特别是 在我们的高危人群中，不良结果和不良事件的基线风险较高。最后，一个 全面了解远程医疗差异需要了解患者的看法和 提供商对远程医疗的偏见，这是尚未解决的重要问题。为了填补这些关键 知识差距，我们建议在医疗保险受益人中进行一项基于人群的全面队列研究 对于癌症，纳入与提供有关提供者、医院和区域数据的二级数据集的链接 因素。我们将通过以下目标评估远程医疗对弱势癌症人群的影响：1) 识别并描述 COVID-19 大流行期间和之后远程医疗方面的差异； 2）评估 远程医疗对高危人群癌症治疗的有效性和安全性的影响； 3）定义 远程医疗利用中可操作的患者层面的障碍和提供者的偏见。这项拟议的研究将有助于 定义癌症患者远程医疗的全国格局，并将提供一个框架 制定未来的干预措施以优化高危患者的远程医疗。这个及时的项目将交付 为提供者、医疗保健系统和政策制定者提供可操作的信息。总体而言，公平、安全、 有效的远程医疗服务将增加获得护理的机会并减少我们之间的癌症健康差距 最脆弱的癌症患者。