Examining Telehealth Use in Skilled Nursing Facilities, with a Focus on Patients with Alzheimer's Disease and Related Dementias

项目总结/摘要 CMS于2020年3月扩大了医疗保险受益人的远程医疗覆盖范围，消除了 在专业护理机构提供远程保健。虽然远程医疗有可能减少 对于SNF中的患者来说，可避免的再入院和急诊室就诊非常有限， 在SNF中为Medicare受益人提供远程医疗服务的影响的证据。此外，虽然粗略 SNF中25%的医疗保险受益人被诊断患有阿尔茨海默病和相关痴呆症（ADRD）， 没有人口水平的证据表明SNF中的远程保健服务对ADRD受益人的影响。 虽然远程医疗可以改善ADRD患者获得必要的专科护理的机会， 远程医疗使用的ADRD特定障碍。该提案的总体目标是审查远程保健 远程医疗服务的增长以及对医疗保险受益人的利用率、成本和护理质量的影响 与ADRD在SNF和受益人一般在SNF，并审查提供远程保健的促进者， SNF。通过拟议的培训计划，其中包括正式课程、讲习班和 临床轮换，以及NIH资助的研究人员的多学科导师团队，申请人将 获得PAC患者治疗的临床知识，重点关注ADRD患者， 定性和混合方法，以及对远程保健实施的理解。余博士将使用这些方法 通过这些培训活动获得的知识和内容，以实现以下具体目标：（1） 检查所有SNF患者和SNF ADRD患者的远程医疗使用模式， 医疗保险覆盖范围的扩大，并评估SNF远程医疗和亲自访问的相对变化;（2） 估计SNF远程保健提供与所有SNF的利用、成本和护理质量之间的关系 患者和患有ADRD的SNF患者;以及（3）识别与远程医疗相关的SNF特征 支持或阻碍SNF提供远程保健的因素，以及远程保健工具和技术， ADRD患者这个应用程序是创新的，因为它利用了一种准实验性的方法， 估计远程医疗使用的因果效应，以及提供细致入微的见解的混合方法 在SNF中提供远程医疗，包括SNF中远程医疗的当前和新兴用途， ADRD。这项拟议中的研究意义重大，因为它将提供新的关键证据，说明 SNF患者的远程医疗使用，重点关注ADRD患者以及如何向患者提供远程医疗 与ADRD合作，这可能会为远程保健覆盖政策和PAC远程保健投资的目标提供信息。这 K01 研究者 患者 该奖项将为余博士提供成为R 01资助的独立人士所需的培训和指导 领导一项关于PAC环境中老年人远程医疗使用的研究计划，重点是 关于ADRD

PROJECT SUMMARY/ABSTRACT CMS expanded telehealth coverage for Medicare beneficiaries in March 2020, removing multiple barriers to the provision of telehealth in skilled nursing facilities (SNFs). While telehealth has the potential to reduce potentially avoidable hospital readmissions and emergency department visits for patients in SNFs, there is very limited evidence on the impact of telehealth provision for Medicare beneficiaries in SNFs. Furthermore, although roughly 25% of Medicare beneficiaries in SNFs have a diagnosis of Alzheimer's disease and related dementias (ADRD), there is no population-level evidence on the impact of telehealth provision in SNFs for beneficiaries with ADRD. Although telehealth may improve access to necessary specialty care for patients with ADRD, there are numerous ADRD-specific barriers to telehealth use. The overall objectives for this proposal are to examine telehealth growth and the effect of telehealth provision on utilization, cost, and quality of care for Medicare beneficiaries with ADRD in SNFs and for beneficiaries generally in SNFs, and to examine facilitators of telehealth provision in SNFs. Through the proposed training plan, which includes a combination of formal coursework, workshops, and clinical rotations, as well as a multi-disciplinary mentorship team of NIH-funded investigators, the applicant will gain clinical knowledge on the treatment of PAC patients, with a focus on patients with ADRD, expertise in qualitative and mixed methods, and an understanding of telehealth implementation. Dr. Yu will use the methods and content knowledge gained through these training activities to achieve the following specific aims: (1) Examine the patterns of telehealth use for all SNF patients and for SNF patients with ADRD before and after the expansion of Medicare coverage, and assess the relative change in SNF telehealth and in-person visits; (2) Estimate the relationship between SNF telehealth provision and utilization, cost, and quality of care for all SNF patients and for SNF patients with ADRD; and (3) Identify SNF characteristics associated with telehealth provision, factors supporting or hindering telehealth provision in SNFs, and telehealth tools and technologies for patients with ADRD. This application is innovative because it leverages a quasi-experimental approach to estimate the causal effect of telehealth use, as well as a mixed methods approach to provide nuanced insights into telehealth provision in SNFs, including current and emerging uses of telehealth in SNFs for patients with ADRD. The proposed research is significant because it will provide new, critical evidence on the impact of telehealth use for SNF patients, with a focus on patients with ADRD and on how telehealth is provided to patients with ADRD, which may inform telehealth coverage policies and targeting of telehealth investments in PAC. This K01 investigator patients Award will provide Dr. Yu with the training and mentoring needed to become an R01-funded independent leading a research program on telehealth use for older adults in PAC settings, with a focus on with ADRD.