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

项目总结/摘要-项目2 为应对COVID-19，美国医疗系统的远程医疗利用率迅速增长 流行病随着我们摆脱这一流行病，远程保健已成为人们之间交流的一种新选择， 患者和供应商。癌症护理提供似乎很好地定位，将远程保健纳入标准 病人护理的工作流程。此外，公平实施远程保健有可能增加获得服务的机会 照顾脆弱的病人。然而，新出现的数据表明，远程保健利用率存在差异 在非白人、低收入和非英语国家的人中使用。不公平地执行 远程医疗可能会无意中在我们最脆弱的患者中制造障碍，这可能是矛盾的， 增加癌症健康差距。大规模严格的研究评估远程保健利用的差异 在COVID-19后的癌症护理环境中缺乏。此外，研究还没有解决如何 与传统的面对面访问相比，远程保健的使用影响了护理的安全性和质量， 在我们的高危人群中，不良结局和不良事件的基线风险较高。最后 要全面了解远程医疗的差异，就需要了解患者的看法， 提供者偏向远程保健，这是尚未解决的重要问题。为了填补这些关键的 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 与癌症，纳入链接到二级数据集提供数据的供应商，医院， 因素我们将通过以下目标评估远程医疗对弱势癌症人群的影响： 识别和描述COVID-19大流行期间和之后远程医疗的差异; 2）评估 远程保健对高危人群中癌症治疗的有效性和安全性的影响;以及3）定义 可采取行动的病人一级的障碍和提供者的偏见与远程保健的利用。这项研究将有助于 定义癌症患者远程保健的国家景观，并将为 制定未来的干预措施，以优化高危患者的远程保健。这个及时的项目将提供 为提供者、医疗保健系统和决策者提供可操作的信息。总体而言，公平，安全， 有效的远程保健服务将增加获得护理的机会，减少我们之间的癌症健康差距。 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.