Transition to Telehealth for Mental Health Care in the Wake of COVID-19

项目摘要 美国对新冠肺炎的回应引发了精神疾病远程医疗政策的革命性转变 医疗保健，包括扩大提供者报销范围、许可便携性和允许的远程医疗 站台。在新冠肺炎的背景下，美国的心理健康水平如何仍未得到回答 设施已经过渡到远程保健，以及对获取、公平和护理质量的影响。我们提出了一个 纵向、混合方法评估远程保健扩展对获取、公平的影响 和精神卫生保健的质量--根据提供者和患者的观点。 首先，我们使用一种秘密的购物者方法，模拟尝试访问 远程卫生服务，具有全国代表性的1,500家精神卫生治疗机构的样本 年第1年和第2年，创建了一系列服务可用性演变的纵向存储库 远程医疗服务。其次，我们将生成一个唯一的纵向二级数据集 设施、县和州级别的特征，以调查预测远程医疗可用性的关键因素 沿着三个轴：(1)设施特征，如设施类型和设施管理结构；(2) 县级社会经济、种族/族裔和地理差异；以及(3)与COVID有关的州级 立法。第三，在解释性顺序混合方法设计之后，我们将使用来自 秘密购物者调查，以指导关键线人(KI)与20家设施的供应商进行面谈-按以下分层 该设施是否提供远程医疗服务，以及这种情况是否发生在新冠肺炎发病后。KI 访谈将提供有关提供商对远程医疗的障碍和促进者、 护理，以及他们从患者那里得到的反馈。我们的三个具体目标是： 目标1：对1500家精神健康治疗机构进行纵向秘密购物者调查，以评估 在新冠肺炎大流行期间，患者在获得具体的远程卫生服务方面遇到了一系列障碍。 目标2：创建一个国家数据库，综合设施、县和州的特点，以 审查2015-2022年远程卫生服务可获得性的三组预测因素：(I)设施 特点--包括管理形式和接受的保险；(2)县级种族/民族， 社会经济和地理构成；(Iii)国家层面的新冠肺炎相关政策。 目标3：记录提供远程医疗服务的关键促进者和障碍，提供者的观点 护理质量和患者的反馈，来自KI对提供者的分层样本的访谈。 这项拟议的研究将揭示远程医疗服务快速变化的格局- 包括在获得机会、公平和护理质量方面。在此基础上，我们将追求R01 我们将完成的数据集链接到索赔数据，以检查远程医疗利用率和与患者相关的结果。

Project Summary The response to COVID-19 in the U.S. has generated a transformative shift in telehealth policies for mental health care, including expansion of provider reimbursement, licensure portability, and permitted telehealth platforms. Against the backdrop of COVID-19, it remains unanswered to what extent U.S. mental health facilities have transitioned to telehealth, as well as effects on access, equity and quality of care. We propose a longitudinal, mixed-methods evaluation of the effects of telemental health expansion on access, equity and quality of mental health care—according to provider and patient perspectives. First, using a secret shopper approach, we simulate the patient experience of attempting to access telemental health services with a nationally representative sample of 1,500 mental health treatment facilities in Years 1 and 2, creating a longitudinal repository of the evolution of service availability for a wide array of telemental health services. Second, we will generate a unique, longitudinal secondary dataset that merges facility-, county- and state-level characteristics to investigate key factors that predict telehealth availability along three axes: (i) facility characteristics such as type of facility and facility management structure; (ii) county-level socioeconomic, racial/ethnic, and geographic disparities; and (iii) state-level COVID-related legislation. Third, following an explanatory sequential mixed-methods design, we will use responses from the secret shopper survey to guide key informant (KI) interviews with providers at 20 facilities—stratified by whether the facility offers telehealth services, and whether this occurred following onset of COVID-19. KI interviews will provide key insights on provider perspectives on barriers and facilitators to telehealth, quality of care, and feedback they have received from patients. Our three specific aims are: Aim 1: Conduct a longitudinal secret shopper survey of 1,500 mental health treatment facilities to assess an array of patient barriers to accessing specific telemental health services during the COVID-19 pandemic. Aim 2: Create a national database that synthesizes facility-, county-, and state-level characteristics to examine three sets of predictors of telemental health service availability from 2015-2022: (i) facility characteristics—including forms of management and accepted insurance; (ii) county-level racial/ethnic, socioeconomic, and geographic composition; and (iii) state-level COVID-19 related policies. Aim 3: Record key facilitators and barriers to offering telemental health services, provider perspectives on quality of care, and feedback from patients, drawing from KI interviews with a stratified sample of providers. The proposed study will shed light on the rapidly changing landscape of telemental health services— including with regard to access, equity and quality of care. Building from this, we will pursue an R01 in which we link our completed dataset to claims data to examine telehealth utilization and patient-related outcomes.