Evaluating the role of telehealth in patients with end stage kidney disease (ESKD)

7.项目摘要 美国6000万农村居民年龄更大，更有可能生活在贫困中， 与城市居民相比，他们要么保险不足，要么没有保险。24万农村 终末期肾病（ESKD）患者接受肾脏病治疗的机会较少， 肾移植前评估，并且不太可能接受肾移植。 远程医疗是独特的定位，以克服美国农村的地理障碍，利用电子 信息和电信技术。然而，远程医疗在农村患者中的利用率不足， 一般来说，很少有人知道地理，资源和距离医疗机构如何有助于 农村ESKD患者的护理、结局和生活质量。利用的综合研究， 成本效益、患者和提供者的偏好将是扩大远程医疗的重要一步 专门针对照顾农村ESKD人口的政策。 我们提出了以下具体目标：（1）评估成本，利用率，以及与 农村ESKD患者的远程医疗;（2）将ESKD护理的远程医疗提供与标准的办公室护理进行比较 使用基于模型的成本效益分析对农村ESKD人群进行护理;以及（3）了解 从患者和提供者的角度来看，使用远程保健的促进因素和障碍。 Joel T. Adler，MD，MPH，在本提案中概述。简而言之，它包括深入 课程，以扩大和扩大阿德勒博士的研究技能，与农村的实习经验（风险 美国南部农村的队列研究，以及一项导师计划 由主要研究者和一个具有肾脏疾病、卫生服务和 研究，定性研究，成本效益分析，以及初级临床医生-科学家的指导。 这将有助于候选人满足以下职业目标：（1）获得最先进的专业知识，在大型索赔 数据库，地理信息系统，成本效益和定性研究，（2）申请和 获得R 01补助资金，（3）过渡到学术独立。 完成后，阿德勒博士将了解农村患者的观点与EKSD和供应商对 远程保健，这将是有条不紊的关键，在设计试点研究，告知R 01的建议，以增加 远程保健在人口健康水平上的可及性和利用率，为农村患者提供ESKD。这些努力 最终将全面了解远程医疗在照顾农村ESKD患者中的作用 通过对其利用进行经济评估，对更大规模的实施进行成本效益分析， 并了解这些如何与患者和提供者的偏好保持一致，以告知未来有关远程医疗的政策 使用和偿还。

7. PROJECT SUMMARY The 60 million rural dwellers across the United States are older, more likely to live in poverty, and more likely to be either underinsured or uninsured compared to their urban counterparts. Moreover, the 240,000 rural patients with end stage kidney disease (ESKD) have less access to nephrology care, are less likely to finish pre-kidney transplant evaluation, and are less likely to undergo kidney transplantation. Telehealth is uniquely positioned to overcome geographic barriers of rural America by capitalizing on electronic information and telecommunication technologies. Yet telehealth is underutilized among rural patients in general, and little is known about how geography, resources, and distance to healthcare facilities contribute to access to care, outcomes, and quality of life for rural patients with ESKD. A comprehensive study of utilization, cost-effectiveness, and patient and provider preferences would be an important step in expanding telehealth policies specifically aimed to care for the rural ESKD population. We propose the following specific aims: (1) to assess the costs, utilization, and outcomes associated with telehealth for rural patients with ESKD; (2) to compare telehealth provision of ESKD care to standard in-office care in the rural ESKD population using model-based cost-effectiveness analysis; and (3) to understand facilitators and barriers of using telehealth from the perspective of patients and providers. A detailed training plan for Joel T. Adler, MD, MPH, is outlined in this proposal. In brief, it includes in-depth coursework to extend and expand Dr. Adler’s research skills, a practicum experience with the RURAL (Risk Underlying Rural Areas Longitudinal) Cohort study in the southern rural United States, and a mentorship plan jointly prepared by the principal investigator and a team with expertise in kidney disease, health services research, qualitative research, cost-effectiveness analysis, and the mentorship of junior clinician-scientists. This will help the candidate meet the following career goals: (1) gain state of the art expertise in large claims database, geographic information systems, cost-effectiveness, and qualitative research, (2) apply for and obtain R01 grant funding, and (3) transition to academic independence. When completed, Dr. Adler will have learned the perspectives of rural patients with EKSD and providers on telehealth that will be methodically crucial in designing pilot studies that inform R01 proposals to increase accessibility and utilization of telehealth on a population-health level for rural patents with ESKD. These efforts will culminate in a comprehensive understanding of the role of telehealth in caring for rural patients with ESKD by economic assessment of its utilization, a cost-effectiveness analysis for implementation on a wider scale, and learning how these align with patient and provider preferences to inform future policy regarding telehealth utilization and reimbursement.