The effect of rurality and the COVID-19 pandemic on telemedicine and preventive healthcare use

项目摘要 本次重新提交是对特别强调通知NOT-HS-21-014卫生服务研究的回应， 推进健康公平和NOT-HS-22-002支持初级保健研究职业发展奖。 农村地区居民慢性病、婴儿死亡率、残疾率、门诊护理率较高 敏感的住院率和年龄调整的死亡率比城市同行。生活在农村地区的人们， 特别是那些财力较少的人，在获得初级保健方面也面临许多挑战。到目前为止， 关于2019冠状病毒病大流行对初级保健利用的急性和中度影响，人们知之甚少 农村患者的医疗质量。远程医疗（TM）的快速和广泛采用， 从COVID-19大流行提供了一个独特的机会，了解TM是否可以提高利用率， 农村病人的预防保健质量。迫切需要研究是否存在差异 农村/城市患者的预防保健利用率正在增加，TM是否有所改善， 预防保健使用和保健质量方面的差距扩大。 为了满足这一需要，我们建议解决以下目标：（1）评估预防性治疗频率的变化 接受的护理访问和预防护理方法（例如，面对面、视频、电话、患者门户） （2）检查TM使用和 由于COVID-19，TM在农村和城市患者中使用的初级保健类型 大流行;和（3）评估TM使用对慢性身体和精神疾病护理质量和公平性的影响 2019冠状病毒病大流行导致农村和城市患者的心理健康状况。 我们将使用来自20个州的800多个社区健康中心网络的电子健康记录（EHR）数据 由OCHIN托管和标准化。EHR数据按患者地址进行地理编码，并链接到 美国人口普查和美国农业部农村城市通勤区数据。这些独特的功能将允许使用社区- 数据和地理空间分析，以确定有未满足需求的社区，并帮助确定 影响服务不足的农村患者使用初级保健和结果的因素。这些数据的使用也 代表了农村人口研究的一个重大进展，因为没有 保险或保险失效，其中农村患者比例过高，在索赔数据中缺失 常用于卫生服务研究。农村人口是AHRQ和2020年健康人的优先事项 和国家卫生研究所确定了农村健康差距和缺乏农村健康研究， 最优先的事这项研究的结果将进一步了解COVID-19大流行对 低收入、农村人口以及TM对初级保健使用和质量的影响。这项创新性的研究 该项目有可能改善低收入农村患者的医疗保健服务和护理质量。

Project Summary This resubmission is responding to Special Emphasis Notices NOT-HS-21-014 Health Services Research to Advance Health Equity and NOT-HS-22-002 Supporting Primary Care Research Career Development Awards. Residents in rural areas have higher rates of chronic diseases, infant mortality, disability, ambulatory care sensitive hospitalizations, and age-adjusted mortality than their urban counterparts. People living in rural areas, particularly those with fewer financial resources, also face many challenges accessing primary care. To date, little is known about the acute and intermediate effects of the COVID-19 pandemic on primary care utilization and quality of care among rural patients. The rapid and wide-scale adoption of telemedicine (TM) resulting from the COVID-19 pandemic provides a unique opportunity to understand if TM can improve utilization or quality of preventive healthcare for rural patients. Research is critically needed to examine whether differences in preventive care utilization among rural/urban patients is increasing and whether TM has improved or worsened disparities in preventive care use and quality of care. To meet this need we propose to address the following aims: (1) assess changes in frequency of preventive care visits and method of preventive care received (e.g., in-person, video, phone, patient portal) among rural and urban patients as a result of the COVID-19 pandemic; (2) examine differences in the use of TM and the type of primary care for which TM was used among rural and urban patients as a result of the COVID-19 pandemic; and (3) evaluate the effect of TM use on the quality and equity of care for chronic physical and mental health conditions among rural and urban patients as a result of the COVID-19 pandemic. We will use electronic health record (EHR) data from a network of 800+ community health centers in 20 states that are hosted and standardized by OCHIN. The EHR data are geocoded to patient addresses and linked to US Census and USDA Rural Urban Commuting Area data. These unique features will allow use of community- level data and geospatial analysis to identify communities with unmet needs and help identify contextual factors affecting use of primary care and outcomes for underserved, rural patients. Use of this data also represents a significant advancement in the study of rural populations because data on patients without insurance or lapses in insurance, of which rural patients are overrepresented, are missing from claims data often used in health services research. Rural populations are a priority for AHRQ, and Healthy People 2020 and the National Institute of Health identified rural health disparities and the lack of research on rural health as top priorities. Findings from this research will advance knowledge on the impact of the COVID-19 pandemic on low-income, rural populations and the effect of TM on use and quality of primary care. This innovative research project has the potential to improve healthcare access and quality of care for low-income, rural patients.