Access, Utilization and Outcomes of Cancer Services in the Era of Telemedicine

远程医疗时代癌症服务的获取、利用和结果

• 批准号: 10368642
• 负责人: Tracy Onega
• 金额: $ 38.66万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10368642
• 关键词: Address; Adoption; American; Area; Automobile Driving; Black race; Bladder; Breast; COVID-19 pandemic; Cancer Patient; Catchment Area; Censuses; Clinical; Colon; Communication; Data; Dimensions; Emergency department visit; Fee-for-Service Plans; Geographic Locations; Geography; Health Policy; Health Services Accessibility; Health Status; Hospitalization; Individual; Link; Lung; Malignant Neoplasms; Massachusetts; Measures; Medicare; Medicare claim; Methodology; Methods; Modeling; Outcome; Pancreas; Patients; Pattern; Policies; Population; Population Characteristics; Population Heterogeneity; Provider; Rectum; Rural; Rural Population; Service delivery model; Services; Signal Transduction; South Dakota; Specialist; Subgroup; Telemedicine; Testing; Time; Transcend; Travel; Treatment Protocols; Visit; Work; age group; base; beneficiary; cancer care; cancer health disparity; care coordination; care delivery; care outcomes; cohort; gaps in access; geographic difference; geographic population; geographically distant; health care availability; health care delivery; health care disparity; health disparity; health equity; improved; inpatient service; melanoma; mortality; mortality disparity; novel; pandemic disease; population based; rural area; rural cancer care; sociodemographics; symptom management; telehealth; uptake; virtual

ABSTRACT Use of telehealth has skyrocketed since the start of the COVID-19 pandemic. Pre-pandemic, only 60,000 of the 63 million fee-for-service Medicare beneficiaries received a telehealth service each month compared to 24.5 million from March to October, 2020, with wide geographic variation in that uptake (e.g. 8.4% in South Dakota to 47.6% in Massachusetts). This telehealth expansion comes at a time when the often-severe access issues for rural individuals have become a focus for health policy and equity. Longer travel times for rural cancer patients have been shown to negatively impact treatment regimens, RCT participation, and symptom management. Multi-specialist teams are often required for comprehensive cancer care, making care coordination in rural areas particularly challenging. These barriers have contributed to the widening gap in cancer mortality between rural and urban patients. Measuring access to cancer care is a fundamental component of both identifying gaps in access, as well as developing care delivery models to mitigate disparities. Because telehealth transcends geographic proximity, it holds great promise for addressing rural cancer care access inequities. Telehealth allows specialists to connect with geographically distant patients and providers who otherwise would have had more restricted options for referral. With the expected persistence of expanded telehealth following the COVID-19 pandemic, the time is now to develop new ways to measure access to cancer care that integrate geospatial measures with telehealth and referral patterns in order to improve equity in health care access and outcomes. Telehealth is now integral to rural cancer care in some regions, yet where gaps are in its use and how inequities in access impact utilization and outcomes is unknown. Only by measuring the new reality of cancer care access that includes telehealth, understanding telehealth impacts on outcomes, and applying this evidence to “what if” scenarios/projections, can we begin to harness and proactively direct the potential that telehealth has to reduce rural cancer disparities. This study will take the critical and timely steps of developing measures of access nationally that incorporate telehealth, identifying determinants of telehealth use in cancer care, testing effects of telehealth on cancer outcomes, and analyzing the projected impact on equity in cancer care access and outcomes if telehealth use in cancer is expanded, while considering differential effects based on the rural-urban continuum. To do this, we will use national Medicare claims for telehealth utilization among cancer patients, Federal Communications Commission (FCC) broadband data, and 2020 Census data for the entire U.S., to extend our prior geospatial cancer care access work (R21CA212687) and population-based outcomes modeling with policy relevance.

抽象的 自 COVID-19 大流行开始以来，远程医疗的使用量猛增。大流行前，只有 60,000 每月有 6,300 万按服务收费的 Medicare 受益人接受远程医疗服务，而这一比例为 24.5 2020 年 3 月至 10 月期间，这一数字的地域差异很大（例如南达科他州为 8.4%） 马萨诸塞州为 47.6%）。这种远程医疗扩张正值经常出现严重的访问问题之际 农村个人的健康问题已成为卫生政策和公平的焦点。农村癌症传播时间较长 患者已被证明对治疗方案、随机对照试验参与和症状产生负面影响 管理。综合癌症护理通常需要多专家团队，使护理 农村地区的协调尤其具有挑战性。这些障碍导致差距不断扩大 农村和城市患者的癌症死亡率。衡量癌症治疗的可及性是一个基本原则 识别获取差距以及开发护理服务模式以缓解 差异。由于远程医疗超越了地理邻近性，因此它为解决农村问题提供了巨大的希望。 癌症护理获取不平等。远程医疗允许专家与地理遥远的患者建立联系， 否则，他们的转诊选择将受到更多限制。随着预期的持续 在 COVID-19 大流行之后，远程医疗得到了扩展，现在是时候开发新的衡量方法了 获得将地理空间措施与远程医疗和转诊模式相结合的癌症护理，以便 改善医疗保健获取和结果的公平性。远程医疗现已成为一些农村癌症护理的组成部分 地区，但其使用方面存在哪些差距，以及获取方面的不平等如何影响利用和成果 未知。只有通过衡量癌症护理获取的新现实，包括远程医疗、了解 远程医疗对结果的影响，并将这些证据应用于“假设”场景/预测，我们可以开始 利用并积极引导远程医疗的潜力来减少农村癌症差异。这项研究将 采取关键而及时的步骤，在全国范围内制定纳入远程医疗的准入措施， 确定癌症护理中远程医疗使用的决定因素，测试远程医疗对癌症结果的影响，以及 分析如果远程医疗在癌症中的使用对癌症护理获取和结果公平性的预计影响 扩大，同时考虑基于城乡连续体的差异效应。为此，我们将使用 国家医疗保险对癌症患者远程医疗利用的索赔，联邦通信 委员会 (FCC) 宽带数据以及整个美国的 2020 年人口普查数据，以扩展我们之前的地理空间 癌症护理获取工作（R21CA212687）和具有政策相关性的基于人群的结果建模。