COVID-19 Telehealth Policies' Impact on Provision of Alcohol and Substance Use Disorder Services at Federally Qualified Health Centers

摘要 在美国，酒精和物质使用障碍（AUD和SUD）非常普遍， 死亡率、发病率、个人和社会成本的既定原因。有大量未满足的需求， 可访问的AUD和SUD治疗选项，但远程医疗已被证明是一种有效的解决方案， 消除治疗障碍，特别是对得不到充分服务的人群。2019冠状病毒病大流行 通过调整现有技术和放松对远程医疗使用的管制，迅速转向远程医疗， 到面对面的服务。采用远程医疗进行AUD和SUD治疗可能对以下患者特别有利： 解决医疗服务不足的人群获得医疗服务的问题，例如联邦合格医疗机构提供的医疗服务。 保健中心。结果将确定远程保健政策（即，纯音频远程医疗，提供者类型 扩展，服务类型扩展），这些措施在大流行期间有效地为健康状况的持久变化提供信息 改善获得AUD和SUD服务的系统。核心假设是， COVID-19期间的远程医疗将与AUD和SUD服务利用率的增加呈正相关， 服务不足的人群。我们的具体目标如下：1.对州医疗补助COVID进行法律的分析- 19项远程保健政策; 2.评估关于AUD和SUD服务利用率的州医疗补助远程医疗政策， 3.分析州医疗补助COVID-19远程医疗政策对CMEHC特殊人群的影响。 该研究将利用互联健康政策中心的COVID-19远程医疗政策资源 用于关于患者特征的结果数据的策略数据和CRISHC程序数据（例如，人口统计资料） 以及所提供的服务（例如，AUD和SUD服务的访视次数和患者人数）。我们会进行 一系列差异中的差异模型，并使用其他分析方法，使用纵向数据进行比较 通过对州医疗补助远程医疗政策的法律的研究制定的分类远程医疗政策。目标 由于COVID-19导致的远程医疗政策变化，拟议研究的本质是创新的 大流行是新的，并提供了一个独特的机会，以评估远程医疗对澳大利亚和南方的影响 获得和利用，特别是对得不到充分服务的人口。确定改善获得澳元机会的政策 SUD的护理和治疗将对大流行后的卫生服务产生持久和重大的影响， 例如永久性政策采用或应用于不同的支付者、环境和人群。

ABSTRACT In the United States, alcohol and substance use disorders (AUD and SUD) are highly prevalent and are established causes of mortality, morbidity, individual and societal costs. There is significant unmet need in accessible AUD and SUD treatment options, however telehealth is demonstrated to be an effective solution to addressing barriers to treatment, especially for underserved populations. The COVID-19 pandemic necessitated a rapid pivot to telehealth by adapting available technologies and deregulating telehealth use as a replacement to in-person services. Adoption of telehealth for AUD and SUD treatment may be particularly advantageous for addressing issues of access for medically underserved populations, such as those served by Federally Qualified Health Centers (FQHCs). Results will identify telehealth policies (i.e., Audio-only Telehealth, Provider Type Expansion, Service Type Expansion) that were effective during the pandemic to inform lasting changes to health systems improving access to AUD and SUD services. The central hypothesis is that policies supporting telehealth during COVID-19 will be positively associated with increased AUD and SUD service utilization in underserved populations. Our specific aims are as follows: 1. Conduct legal analysis of state Medicaid COVID- 19 telehealth policies; 2. Evaluate state Medicaid telehealth policies on AUD and SUD service utilization at FQHCs, and 3. Analyze impact of state Medicaid COVID-19 telehealth policies on FQHC special populations. The study will employ the Center for Connected Health Policy's Policy Finder resource for COVID-19 telehealth policy data and FQHC program data for outcome data on patient characteristics (e.g., demographic information) and services provided (e.g., number of visits and number of patients for AUD and SUD services). We will conduct a series of differences-in-differences models and use other analytic methods using longitudinal data to compare categorized telehealth policies developed through legal research on state Medicaid telehealth policies. The aims of the proposed study are inherently innovative as the telehealth policy changes resulting from the COVID-19 pandemic are novel and present a unique opportunity to evaluate the impact of telehealth on AUD and SUD access and utilization, particularly for underserved populations. Identifying policies that improve access to AUD and SUD care and treatment will have lasting and significant implications for health services after the pandemic, such as permanent policy adoption or application to different payors, settings, and populations.