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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

基本信息

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
项目类别：
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

项目摘要

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.

摘要