Evaluating the Impact of Telemedicine on Ambulatory Care

项目摘要/摘要 背景资料：2020年前6个月，1000万医疗保险受益人使用远程医疗 相比之下，2019年前六个月仅有134,000项服务。远程医疗政策在 新冠肺炎大流行催化了一场持续的门诊护理提供的重大变革-目前 每5次门诊护理中就有1次是通过远程医疗进行的。虽然州和联邦机构已经 长期以来，远程医疗一直被定位为改善健康的手段，大流行后的远程医疗政策制定 由于缺乏关于远程医疗对医疗保健服务的广泛影响的证据， 质量和成本。例如，制定永久性的远程医疗政策以促进 在不了解阻碍远程医疗的患者、提供商和市场障碍的情况下公平使用远程医疗 使用。此外，虽然广泛使用远程医疗有可能改善临床结果，如 在可预防的住院率方面，缺乏关于这一主题的经验数据。最后，虽然对 在政策制定方面，远程医疗的使用对医疗保险支出和利用的广泛影响尚未 以前研究过的。年颁布的医疗保健政策导致远程医疗使用的急剧增加 新冠肺炎大流行为解决这些长期存在的知识提供了前所未有的机会 差距。 总体战略：在这项研究中，我们建议使用当代的全国医疗保险队列 受益者辅以详细的供应商和市场数据，以调查与以下方面相关的因素 远程医疗的使用，以及远程医疗对门诊护理结果和医疗支出的影响。 研究目标：1)确定远程医疗使用的患者、提供者和市场层面的决定因素。我们会 探索远程医疗在特定感兴趣人群中使用的异质性，包括 农村地区、老年人、种族/族裔少数群体或社会经济上的弱势群体。2)评估 门诊敏感患者远程医疗实践水平与入院人数的关系 条件。3)评估临床医生级远程医疗使用对30天人均总费用的影响。 影响：这项研究的结果将直接向主要不确定性领域提供信息，并提供关键证据 为远程医疗决策提供信息。

PROJECT SUMMARY/ABSTRACT BACKGROUND: During the first six months of 2020, 10 million Medicare beneficiaries used telemedicine services compared to only 134,000 during the first six months of 2019. Telemedicine policy changes during the COVID-19 pandemic catalyzed a major transformation of ambulatory care delivery that is sustained—currently 1 out of 5 ambulatory care visits are performed through telemedicine. While state and federal agencies have long positioned telemedicine as a means to improve health, post-pandemic telemedicine policymaking is hindered due to the scarcity of evidence on the broad scale impact of telemedicine on healthcare access, quality and costs. For instance, it is challenging to enact permanent telemedicine policies that facilitate the equitable use of telemedicine without an understanding of patient, provider and market barriers that impede its use. Furthermore, while widespread telemedicine use has the potential to improve clinical outcomes such as preventable hospital admission rates, there is a lack of empirical data on this topic. Finally, while essential for policymaking, the broad scale impact of telemedicine use on Medicare spending and utilization has not been previously studied. The dramatic increase in telemedicine use as a result of healthcare policies enacted during the COVID-19 pandemic provides an unprecedented opportunity to address these long-standing knowledge gaps. OVERALL STRATEGY: In this study, we propose using a contemporary, national cohort of Medicare beneficiaries supplemented with detailed provider and market-level data to investigate factors associated with telemedicine use, and the impact of telemedicine on ambulatory care outcomes and healthcare spending. RESEARCH AIMS: 1) To identify patient, provider and market-level determinants of telemedicine use. We will explore heterogeneity in telemedicine use across specific populations of interest, including beneficiaries that are rurally located, elderly, racial/ethnic minorities, or socioeconomically disadvantaged. 2) To evaluate the association between practice-level telemedicine use and hospital admissions for ambulatory care sensitive conditions. 3) To evaluate the impact of clinician-level telemedicine use on 30-day total per capita costs. IMPACT: Findings from this study will directly inform major areas of uncertainty and provide key evidence to inform telemedicine policymaking.