Telemedicine and health disparities among community-dwelling older adults with ADRD during COVID-19 pandemic

项目摘要。社区居住的ADRD老年人面临着重大挑战， COVID-19大流行：他们不仅面临COVID-19感染和死亡的高风险， 通常的门诊治疗中断的负面后果的风险。老年ADRD患者 护理需求，并依赖于及时和定期的门诊护理来管理ADRD和其他并存疾病。 在少数种族/族裔ADRD患者中，常规护理中断的后果可能更严重， 因为黑人和西班牙裔通常比他们的白色同行有更大的疾病负担。提高 为了扩大医疗服务，CMS于2020年3月扩大了远程医疗的覆盖范围。虽然出现 从那时起，远程医疗的使用显着增加，目前尚不清楚CMS的远程医疗政策如何 影响社区居住的ADRD老年人的护理;以及它如何因种族/民族而异 少数群体事实上，有人担心远程医疗政策可能会扩大种族/民族差异， 保健因此，本研究的主要目的是了解CMS的影响， 社区居民中与COVID无直接关系医疗保健使用的远程医疗政策 老年ADRD患者及其种族/民族差异。本研究有三个具体目的： 社区居住老年人在利用常规门诊治疗方面的种族/民族差异 ADRD，CMS远程医疗政策变化前后。我们假设黑人和西班牙裔 在实施远程医疗政策后，普通门诊就诊人数比白人少， 卫生保健利用。我们将从几个方面来研究普通门诊服务的利用情况。SA2.To 研究远程医疗政策和门诊护理之间关系的种族/民族差异 敏感（ACS）住院、急诊室（ER）就诊和观察。我们假设 患有ADRD的少数种族/民族不太可能从远程医疗的扩展中受益， 这些ACS急性事件。我们还将研究如果发现差异， 远程医疗将采用几种统计模型（如中断时间序列回归）并进行分层 将对SA 1和SA 2进行分析（按社区的州和社会经济地位）。SA 3.探讨 照顾者对白色、黑色和黑色人群使用远程医疗的好处、障碍和挑战的看法 和西班牙裔社区老年人ADRD。这项研究是创新的，因为它是 第一次研究远程医疗政策与健康之间关系中的种族/民族差异 护理利用社区居住的老年人与ADRD，通过使用混合方法的方法。这 拟议的研究意义重大，因为研究结果将提供有关改善ADRD之间护理公平性的信息 在大流行期间和之后，人口都受到影响。研究结果也将为未来的研究提供前提， 在更大范围内收集数据，以了解这一人群健康差异的根本原因。

Project Summary. Community-dwelling older adults with ADRD face significant challenges under the pandemic of COVID-19: they are not only at high risks for COVID-19 infection and mortality, but also at high risks for the negative consequences of a disruption in usual outpatient care. Older adults with ADRD have high care needs and rely on timely and regular outpatient care to manage ADRD and other co-exiting conditions. The consequence of disruption in usual care could be even greater among racial/ethnic minorities with ADRD, as Blacks and Hispanics generally have a greater disease burden than their white counterparts. To improve care access, the CMS expanded the coverage of telemedicine in March 2020. Although there has been significant increase in the telemedicine use since then, it is unknown how the CMS' telemedicine policy affects care among community-dwelling older adults with ADRD; and how it varies by racial/ethnic minorities. Indeed, there are concerns that the telemedicine policy may widen racial/ethnic disparities in health care. Therefore, the main objective of this proposed research is to understand the effect of CMS' telemedicine policy on health care utilization that are not directly related to COVID among community-dwelling older adults with ADRD, and its variations by race/ethnicity. This study has 3 Specific Aims: SA1.To examine racial/ethnic disparities in the utilization of usual outpatient care among community-dwelling older adults with ADRD, before and after changes in CMS telemedicine policy. We hypothesize that Blacks and Hispanics have fewer usual outpatient visits than whites after the implementation of telemedicine policy, accounting for prior health care utilization. We will examine the utilization of usual outpatient care from several dimensions. SA2.To examine racial/ethnic disparities in the relationship between the telemedicine policy and ambulatory care sensitive (ACS) hospitalizations, emergency room (ER) visits and observation stays. We hypothesize that racial/ethnic minorities with ADRD are less likely to benefit from the expansion of telemedicine, in preventing these ACS acute events. We will also examine how the disparities, if detected, are affected by the access to telemedicine. Several statistical models (e.g. interrupted time series regression) will be adopted and stratified analyses (by state and socio-economic status of a community) will be performed for SA 1&2. SA3. To explore caregivers' perspectives regarding benefits, barriers and challenges of telemedicine use among white, Black and Hispanic community-dwelling older adults with ADRD. This proposed research is innovative because it is the first study to examine racial/ethnic disparities in the relationship between the telemedicine policy and health care utilization among community-dwelling older adults with ADRD, by using a mixed-method approach. This proposed study is significant because findings will provide information on improving care equity among ADRD population, both during the pandemic and beyond. Findings will also provide the premise for future studies to collect data on a larger scale to understand the root cause in health disparities among this population.