Telemedicine Utilization and Impacts on Access Among Rural Medicare Beneficiaries

项目摘要/摘要 候选人：Krisda H.Chaiyachati，医学博士，公共卫生硕士，MSHP是一名普通内科医生和早期健康服务 调查人员热衷于改善弱势、老年和农村地区获得医疗保健的机会和健康结果 成年人。他寻求在老龄化研究和卫生经济学培训方面的内容专业知识，以使他向 独立，并促进他的职业道路，以改善老年人的医疗保健机会。 研究背景：随着初级保健提供者的减少，农村老年美国人正面临严重的获取危机 专家在农村地区工作，照顾越来越老、越来越穷、越来越多病的人口。远程医疗 已经被提出作为帮助克服访问障碍的一种解决方案，但它是否想要实现这一点 结果还不得而知。在按服务收费的医疗保险计划中--农村老年人最常见的保险 自2004年以来，美国的远程医疗以每年128%的速度增长。了解农村、老年人 访问有限的美国人使用过远程医疗，这些访问如何改变了访问，以及是否 远程医疗的使用减少了急诊科就诊或住院治疗仍然是 如果要将远程医疗作为提供医疗保健的一种有价值的方式来推广，政策制定者和提供者。 具体目标：(1)衡量远程医疗使用与面对面护理障碍之间的关联：居住 在供养者较少、患有老年疾病或生活在联邦贫困线以下的县；(2) 衡量最初的专科远程医疗访问是后续访问还是第一次访问以及协会 面对面护理的障碍与后续或首次远程医疗访问的频率之间的关系；以及(3) 衡量远程医疗使用与随后的急性护理就诊之间的关联(急诊科 或住院)，特别是在患有老年病的患者中。 研究计划：为了实现这些目标，Chaiyachati博士将学习和开发准实验， 对包含2010-2018年费的大型管理数据文件进行实证分析的计量经济技术 服务Medicare B部分投保人结合提供者提供的措施、患者的社会人口统计数据，以及 地理指标(例如，乡村、宽带接入和交通)。 职业发展计划：Chaiyachati博士将(1)将他的热情和观点集中在以下需求上 老年人；(2)培养健康经济学家用来研究大型行政管理的分析方法方面的专业知识 数据文件；以及(3)发展关于远程医疗如何被使用及其在现实世界环境中的影响的专业知识。Dr。 Chaiyachati的职业发展将得到国际专家的密切指导 老年学、卫生经济学、远程医疗和卫生政策。 环境：宾夕法尼亚大学为他继续进行培训提供了理想的环境， 著名的导师致力于他的成功，这是一所资源充足的跨学科机构，拥有 培养成功的、世界知名的、独立的老龄健康服务研究人员的记录。

PROJECT SUMMARY / ABSTRACT Candidate: Krisda H. Chaiyachati, MD, MPH, MSHP is a general internist and early-stage health services investigator passionate about improving access to health care and health outcomes for vulnerable, older, rural adults. He seeks content expertise in aging research and training in health economics to transition him towards independence and catalyze his career path towards improving health care access for older adults. Research Context: Rural, older Americans are facing an acute access crisis as fewer primary care providers and specialists work in rural areas to care for an increasingly older, poorer, sicker population. Telemedicine has been proposed as one solution to help overcome access barriers, but whether it is achieving this wanted outcome is unknown. Within fee-for-service Medicare plans—the most common insurance for rural, older Americans—telemedicine has been growing 128% per year since 2004. Understanding whether rural, older Americans with limited access have used telemedicine, how these visits have altered access, and whether telemedicine use reduces emergency department visits or hospitalizations remain fundamental questions for policymakers and providers if telemedicine is going to be promoted as a valuable way to deliver health care. Specific Aims: (1) Measure the association between telemedicine use and barriers to in-person care: residing in a county with fewer providers, having geriatric conditions, or living below the federal poverty level; (2) measure whether initial specialty telemedicine visits were follow-up visits or first-time visits and the association between barriers to in-person care and the frequency of follow-up or first-time telemedicine visits; and (3) measure the association between telemedicine use and subsequent acute care visits (emergency departments or hospitalizations), particularly among patients with geriatric conditions. Research Plan: To accomplish these aims, Dr. Chaiyachati will learn and develop quasi-experimental, econometric techniques to empirically analyze a large administrative datafile containing 2010-2018 fee-for- service Medicare Part B enrollees combined with provider supply measures, patient sociodemographics, and geographic indicators (e.g., rurality, broadband access, and transportation). Career Development Plan: Dr. Chaiyachati will (1) concentrate his passion and perspective on the needs of older adults; (2) develop expertise in analytic methods used by health economists to study large administrative datafiles; and (3) develop expertise in how telemedicine is being used and its impact in real-world settings. Dr. Chaiyachati's career development will be supported by close mentorship from international experts in geriatrics, health economics, telemedicine, and health policy. Environment: The University of Pennsylvania offers the ideal environment for him to pursue this training, with well-established mentors dedicated to his success and it is a well-resourced, interdisciplinary institution with a track record of producing successful, world-renowned, independent, health services researchers in aging.