Impact of Telemedicine on Medicare Beneficiaries with Mental Illness

远程医疗对患有精神疾病的医疗保险受益人的影响

基本信息

批准号：
10063830
负责人：
Ateev Mehrotra
金额：
$ 64.32万
依托单位：
HARVARD MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-12-01 至 2022-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10063830
关键词：
Address Adult Affect Area Automobile Driving Caring Clinical Clinical Trials Communities Complement Congresses Data Data Analyses Diffusion Disabled Persons Emergency department visit Evaluation Future Geography Growth Health Personnel Health Services Accessibility Health system Hospitalization Improve Access Insurance Internet Intervention Interview Knowledge Laws Literature Low income Medicaid Medicare Mental Depression Mental Health Mental disorders Methods Modeling National Institute of Mental Health Outcome Patient Care Patients Pattern Penetration Persons Policies Population Provider Psyche structure Psychotic Disorders Quality of Care Randomized Regulation Research Rural Rural Community Sampling Schizophrenia Series Specialist Speed Structure Telemedicine Telemental Testing Training Variant Videoconferencing Visit Work base beneficiary care costs contextual factors control trial demographics design disadvantaged population experience geographic difference improved improved outcome innovation interest machine learning method medical specialties medication compliance older patient population health programs racial and ethnic disparities rapid growth rural area severe mental illness statistical and machine learning trend trial comparing underserved community uptake

项目摘要

PROJECT SUMMARY Access to mental health specialists is difficult for many patients in the U.S., particularly for the poor and those who live in rural communities. Telemental health is one potential solution for this access problem, and there has been rapid growth in the number of live video-based telemental health visits in the U.S. While there are numerous rigorous randomized-control trials comparing telemental health visits to in-person mental health specialist care, there have been little research on how telemental health is being used in real-world settings. The uptake of telemental health has been very uneven geographically, and what explains this variation is also largely unknown. Our mixed-methods proposal centers on filling these gaps in knowledge. Under the first aim, we will conduct a series of descriptive analyses of data on 75 million adults with Medicare or commercial insurance to understand how telemental health is being used in conjunction with in-person care and whether the growth of telemental health has decreased disparities in the use of mental health specialists among disadvantaged populations. Under the second aim, we seek to explain why there is geographic variation in uptake using robust statistical machine learning. Under the third aim, we exploit the variation in uptake to assess whether communities with greater telemental health penetration have experienced improvements in care for patients with mental illness. In the fourth aim we will conduct qualitative interviews with providers to complement the empirical analyses and understand the key contextual factors underlying our findings. Understanding how telemental health is being used, why there is variation in use of telemental health, and whether telemental health use is associated with higher quality care could help drive future telemental health interventions and influence the ongoing policy debate on telemedicine regulations and reimbursement. Together the results of these aims are consistent with the NIMH's expressed interest in innovative delivery models that can improve care for underserved communities.

项目摘要对于美国的许多患者，尤其是穷人和那些患者，很难获得心理健康专家住在农村社区的人。远程健康是解决此访问问题的潜在解决方案，那里在美国有现场直播的远程健康访问数量的迅速增长将远程健康访问与面对面心理健康进行比较的许多严格的随机控制试验专业护理，几乎没有研究如何在现实世界中使用远程健康。在地理上，远程健康健康的吸收非常不平衡，这解释了这种差异的原因也是在很大程度上未知。我们的混合方法提案集中在填补知识中的这些空白上。在第一个目标下，我们将对拥有Medicare的7500万成人进行一系列描述性分析或商业保险，以了解如何与面对面护理结合使用远程健康远程健康健康的增长是否减少了心理健康专家使用的差异在处境不利的人群中。在第二个目标下，我们试图解释为什么存在地理变化在使用强大的统计机器学习的吸收中。在第三个目标下，我们利用了吸收的变化评估远程远程健康渗透率更高的社区是否经历了改善护理精神疾病的患者。在第四个目标中，我们将对提供者进行定性访谈补充经验分析并了解我们发现的关键背景因素。了解如何使用远程健康的健康，为什么使用远程健康的使用变化以及远程医疗使用是否与高质量的护理有关，可以帮助推动未来的远程健康健康干预和影响远程医疗法规和报销的持续政策辩论。这些目标的结果与NIMH对创新交付的表达兴趣一致可以改善服务不足社区的护理的模型。