Project 2: The Intersection of Telehealth and Health Disparities in At-Risk Older Patients with Cancer

项目摘要/摘要--项目2 响应新冠肺炎，远程医疗在美国医疗系统中的使用率迅速增长 大流行。随着我们从大流行中走出来，远程医疗已成为两国之间沟通的新选择 患者和提供者。癌症护理服务似乎处于有利地位，可以将远程医疗纳入标准 病人护理工作流程。此外，公平地实施远程保健可能会增加获得机会。 在脆弱的病人中进行护理。然而，新出现的数据表明，远程医疗的利用率存在差距 非白人、低收入和不会说英语的个人之间的接触。不公平地执行 远程医疗可能无意中在我们最脆弱的患者之间制造障碍，这可能是自相矛盾的 扩大癌症健康差距。评估远程医疗利用差异的大规模严谨研究 在后新冠肺炎时代，人们缺乏癌症护理环境。此外，研究还没有解决如何 与传统的面对面就诊相比，远程医疗的利用影响了护理的安全性和质量，尤其是 在我们的高危人群中，具有较高的不良结局和不良事件的基线风险。最后，一个 全面了解远程医疗差异需要了解患者的看法和 提供商偏向远程医疗，这代表着重要的未解决的问题。要填补这些关键信息 知识差距，我们建议在医疗保险受益人中进行一项全面的基于人群的队列研究 关于癌症，纳入到提供关于提供者、医院和地区的数据的二级数据集的链接 各种因素。我们将通过以下目标评估远程医疗对癌症脆弱人群的影响：1) 识别和描述新冠肺炎大流行期间和之后远程医疗方面的差异；2)评估 远程保健对高危人群癌症治疗的有效性和安全性的影响；以及3)确定 在远程医疗利用方面，患者层面的障碍和服务提供者的偏见是可行的。这项拟议的研究将有所帮助 定义癌症患者远程医疗的国家版图，并将为 未来干预措施的发展，以优化高危患者的远程保健。这一及时的项目将提供 向提供者、医疗保健系统和政策制定者提供可操作的信息。全面、公平、安全和 有效的远程医疗提供将增加获得护理的机会，并减少我们 最脆弱的癌症患者。

PROJECT SUMMARY/ ABSTRACT – PROJECT 2 Telehealth utilization increased rapidly across the US healthcare system in response to the COVID-19 pandemic. As we emerge from the pandemic, telehealth has become a new option for communication between patients and providers. Cancer care delivery appears well positioned to incorporate telehealth into the standard workflow of patient care. Furthermore, equitable implementation of telehealth could potentially increase access to care among vulnerable patients. However, emerging data suggest disparities with telehealth utilization access among non-White, low income, and non-English speaking individuals. Inequitable implementation of telehealth could inadvertently create barriers among our most vulnerable patients, which could paradoxically increase cancer health disparities. Large-scale rigorous research evaluating disparities in telehealth utilization within the post-COVID-19 cancer care environment is lacking. Furthermore, research has not addressed how telehealth utilization influences safety and quality of care compared to conventional in-person visits, particularly among our at-risk populations with higher baseline risks of poor outcomes and adverse events. Finally, a comprehensive understanding of telehealth disparities requires an understanding of patient perceptions and provider biases towards telehealth, which represent important unaddressed questions. To fill these critical knowledge gaps, we propose a comprehensive population-based cohort study among Medicare beneficiaries with cancer, incorporating linkages to secondary datasets providing data on providers, hospitals, and regional factors. We will assess the impact of telehealth on vulnerable cancer populations through the following aims: 1) identify and characterize disparities in telehealth during and after the COVID-19 pandemic; 2) assess the impact of telehealth on efficacy and safety of cancer delivery among at-risk populations; and 3) define actionable patient-level barriers and provider biases with telehealth utilization. This proposed study will help define the national landscape of telehealth among cancer patients, and will provide a framework for the development of future interventions to optimize telehealth among at-risk patients. This timely project will deliver actionable information to providers, healthcare systems, and policymakers. Overall, equitable, safe, and effective telehealth delivery stands to increase access to care and reduce cancer health disparities among our most vulnerable cancer patients.