Telemedicine-Based Collaborative Care to Reduce Rural Health Disparities

基于远程医疗的协作护理减少农村健康差距

• 批准号: 7875672
• 负责人: JOHN C. FORTNEY
• 金额: $ 2.87万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7875672
• 关键词: Adoption; American; Antidepressive Agents; Area; Arkansas; Arts; Caring; Chronic; Chronic Care; Chronic Disease; Clinic; Clinical; Community Health; Community Health Centers; Computerized Medical Record; Contracts; Country; Disease; Educational workshop; Effectiveness; Electronic Health Record; Emotional; Engineering; Evidence based practice; Evidence based treatment; Face; Fasting; Funding; Future; Goals; Health Policy; Health Services Accessibility; Healthcare; Healthcare Systems; Individual; Information Systems; Intervention; Life; Location; Low income; Medically Underserved Area; Mental Health; Mental Health Services; Minority; Mission; Modeling; Mood Disorders; NIH Program Announcements; National Institute of Mental Health; Outcome; Patient Access to Records; Patients; Physician Executives; Policies; Policy Maker; Population; Primary Health Care; Principal Investigator; Process; Provider; Public Health; Publishing; Randomized Controlled Clinical Trials; Relative (related person); Reporting; Research; Research Infrastructure; Research Personnel; Resources; Rest; Rural; Rural Community; Rural Health; Rural Population; Services; Site; Societies; Specialist; System; Target Populations; Technology; Telemedicine; Telephone; Testing; Translations; United States Dept. of Health and Human Services; United States Health Resources and Services Administration; Veterans; Visit; base; care delivery; care systems; chronic care model; collaborative care; compare effectiveness; cost; cost effectiveness; depression; design; evidence base; experience; health disparity; health related quality of life; high risk; improved; innovation; mental health center; multidisciplinary; novel; organizational structure; outreach; patient population; portability; preference; primary care setting; programs; rural area; rural disparities; satisfaction; severe mental illness; suicide rate; technological innovation; treatment adherence; treatment as usual; web site

Rural individuals with depression face substantial barriers to care, seldom receive evidence-based treatment, and experience poor outcomes. Collaborative care has been documented to improve outcomes in large urban Primary Care (PC) clinics. Implementing collaborative care in small rural practices presents a unique challenge because it is not feasible to employ on-site multidisciplinary care teams dedicated to depression treatment. No published studies have documented the effectiveness of collaborative care in small rural PC clinics. In fact, one recent collaborative care effectiveness study conducted in both rural and urban practices found that outcomes were significantly improved in urban clinics, but not rural clinics. Results from our current VA study demonstrate that telemedicine-based collaborative care is effective in small rural PC clinics. Telemedicine-based collaborative care was provided to rural clinics by an off-site depression care team using telephones, emails, interactive video, and a shared electronic medical record. A critical question for the field is whether it is more effective for small rural clinics to provide collaborative care services on-site (practice-based collaborative care model) or to contract with an off-site care team that specializes in providing collaborative care to multiple clinics from a centralized location using telemedicine technologies (telemedicine-based model). We propose to compare the effectiveness/cost-effectiveness of telemedicine-based collaborative care to practice-based collaborative care in six Community Health Center (CMC) systems in rural Arkansas. In 2003, 890 federally-funded CHCs served over 12 million poor, ethnically diverse patients living in medically underserved areas. CHCs are in the process of re-engineering clinics to provide practice-based collaborative care as a part of the Health Disparities Collaboratives. The proposed research has the potential to have a major public health impact because the results should be generalizable to the hundreds of rural CHCs across the country. CHCs represent one of the largest and fasting growing PC systems in the nation, and thus results should be applicable to a large number of providers and patients across the nation. In addition, CHCs serve predominantly low income minority populations living in medically underserved areas. This population is at high risk for experiencing health disparities and thus, interventions targeting this population have the potential to have a major impact.

农村抑郁症患者面临着巨大的护理障碍，很少接受循证医学治疗。 治疗，效果不佳。协作护理已被证明可以改善结果 在大型城市初级保健（PC）诊所。在小型农村实践中实施协作护理， 独特的挑战，因为它是不可行的，雇用现场多学科护理团队专门为 抑郁症治疗。没有已发表的研究记录了合作护理在以下方面的有效性： 农村小诊所事实上，最近在农村和农村地区进行的一项合作护理有效性研究表明， 城市实践发现，城市诊所的结果得到了显著改善，但农村诊所的情况并非如此。结果 从我们目前的VA研究表明，远程医疗为基础的合作护理是有效的，在小农村 PC诊所远程医疗为基础的协作保健提供了农村诊所的异地抑郁症 护理团队使用电话、电子邮件、交互式视频和共享的电子医疗记录。一个关键 该领域的问题是，小型农村诊所提供合作护理是否更有效 现场服务（基于实践的协作护理模式）或与非现场护理团队签订合同， 专门使用远程医疗从集中位置向多个诊所提供协作护理 技术（基于远程医疗的模型）。我们建议比较以下项目的成效/成本效益： 六个社区卫生服务中心远程医疗协作护理到实践协作护理 (CMC)阿肯色州农村地区的系统。2003年，890个联邦资助的社区卫生中心为1 200多万穷人提供服务， 生活在医疗服务不足地区的不同种族的患者。社区卫生中心正在重新设计 诊所提供基于实践的协作护理，作为健康差异协作的一部分。 拟议的研究有可能产生重大的公共卫生影响，因为结果应该 推广到全国数百个农村社区卫生中心。社区卫生中心是世界上最大的 快速增长的PC系统在全国，因此，结果应该适用于大量的 全国各地的供应商和患者。此外，社区健康中心主要为低收入少数族裔服务。 生活在医疗服务不足地区的人口。这一人群处于经历健康的高风险之中 因此，针对这一群体的干预措施有可能产生重大影响。