Evaluating the Impact of Telemedicine on Ambulatory Care

评估远程医疗对门诊护理的影响

• 批准号: 10606533
• 负责人: Chandy Skaria Ellimoottil
• 金额: $ 35.34万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-08 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606533
• 关键词: Evaluating; Impact; Telemedicine; Ambulatory; Care

PROJECT SUMMARY/ABSTRACT BACKGROUND: During the first six months of 2020, 10 million Medicare beneficiaries used telemedicine services compared to only 134,000 during the first six months of 2019. Telemedicine policy changes during the COVID-19 pandemic catalyzed a major transformation of ambulatory care delivery that is sustained—currently 1 out of 5 ambulatory care visits are performed through telemedicine. While state and federal agencies have long positioned telemedicine as a means to improve health, post-pandemic telemedicine policymaking is hindered due to the scarcity of evidence on the broad scale impact of telemedicine on healthcare access, quality and costs. For instance, it is challenging to enact permanent telemedicine policies that facilitate the equitable use of telemedicine without an understanding of patient, provider and market barriers that impede its use. Furthermore, while widespread telemedicine use has the potential to improve clinical outcomes such as preventable hospital admission rates, there is a lack of empirical data on this topic. Finally, while essential for policymaking, the broad scale impact of telemedicine use on Medicare spending and utilization has not been previously studied. The dramatic increase in telemedicine use as a result of healthcare policies enacted during the COVID-19 pandemic provides an unprecedented opportunity to address these long-standing knowledge gaps. OVERALL STRATEGY: In this study, we propose using a contemporary, national cohort of Medicare beneficiaries supplemented with detailed provider and market-level data to investigate factors associated with telemedicine use, and the impact of telemedicine on ambulatory care outcomes and healthcare spending. RESEARCH AIMS: 1) To identify patient, provider and market-level determinants of telemedicine use. We will explore heterogeneity in telemedicine use across specific populations of interest, including beneficiaries that are rurally located, elderly, racial/ethnic minorities, or socioeconomically disadvantaged. 2) To evaluate the association between practice-level telemedicine use and hospital admissions for ambulatory care sensitive conditions. 3) To evaluate the impact of clinician-level telemedicine use on 30-day total per capita costs. IMPACT: Findings from this study will directly inform major areas of uncertainty and provide key evidence to inform telemedicine policymaking.

项目总结/摘要 背景：在2020年的前六个月，1000万医疗保险受益人使用远程医疗 相比之下，2019年前六个月仅为134，000。2010年期间远程医疗政策的变化 2019冠状病毒病大流行催化了门诊护理服务的重大转变，目前这种转变是持续的， 五分之一的门诊护理是通过远程医疗进行的。虽然州和联邦机构 长期以来，远程医疗被定位为改善健康的一种手段，大流行后的远程医疗决策是 由于缺乏远程医疗对医疗保健服务的广泛影响的证据， 质量和成本。例如，颁布永久性远程医疗政策，促进远程医疗的发展， 公平使用远程医疗，而不了解阻碍其 使用.此外，虽然远程医疗的广泛使用有可能改善临床结果， 关于可预防的住院率，缺乏关于这一主题的经验数据。最后，虽然对于 决策，远程医疗使用对医疗保险支出和利用的广泛影响尚未得到 以前研究过。由于2000年颁布的医疗保健政策，远程医疗的使用急剧增加。 COVID-19大流行为解决这些长期存在的知识提供了前所未有的机会 差距。 总体策略：在这项研究中，我们建议使用一个当代的，全国性的医疗保险队列。 受益人补充了详细的供应商和市场层面的数据，以调查与 远程医疗的使用，以及远程医疗对门诊护理结果和医疗保健支出的影响。 研究目的：1）确定远程医疗使用的患者，提供者和市场水平的决定因素。我们将 探讨特定关注人群中远程医疗使用的异质性，包括受益人， 居住在农村、老年人、少数民族或社会经济弱势群体。2)评价 实践水平的远程医疗使用与门诊护理敏感的住院率之间的关联 条件3)评价临床医生一级远程医疗使用对30天人均总费用的影响。 影响：这项研究的结果将直接告知主要的不确定性领域，并提供关键证据， 为远程医疗决策提供信息。