Impact of Telemedicine on Medicare Beneficiaries with Mental Illness

项目摘要 在美国，许多患者很难接触到心理健康专家，特别是对穷人和那些 who live生活in rural乡村communities社区.基本卫生是解决这一问题的一个潜在办法， 在美国，基于实时视频的远程健康访问数量迅速增长。 许多严格的随机对照试验将远程健康访问与面对面的心理健康进行了比较， 专家护理，很少有关于远程健康如何在现实世界中使用的研究。 远程健康的吸收在地理上是非常不平衡的，解释这种差异的原因也是 大部分未知。我们的混合方法建议集中在填补这些知识空白。 在第一个目标下，我们将对7500万老年人的数据进行一系列描述性分析。 或商业保险，以了解远程医疗如何与个人护理结合使用 以及远程健康的增长是否减少了心理健康专家使用的差异 在弱势群体中。在第二个目标下，我们试图解释为什么存在地理差异 使用强大的统计机器学习。在第三个目标下，我们利用摄取的变化， 评估远程医疗普及率较高的社区是否在以下方面有所改善： 照顾精神病患者。在第四个目标中，我们将与供应商进行定性访谈， 补充实证分析，并了解我们的研究结果背后的关键背景因素。 了解如何使用远程健康，为什么远程健康的使用存在差异，以及 远程医疗的使用是否与更高质量的护理相关， 这将有助于采取干预措施，并影响正在进行的关于远程医疗条例和报销的政策辩论。 这些目标的结果与NIMH对创新交付的兴趣一致 可以改善服务不足社区的护理模式。

PROJECT SUMMARY Access to mental health specialists is difficult for many patients in the U.S., particularly for the poor and those who live in rural communities. Telemental health is one potential solution for this access problem, and there has been rapid growth in the number of live video-based telemental health visits in the U.S. While there are numerous rigorous randomized-control trials comparing telemental health visits to in-person mental health specialist care, there have been little research on how telemental health is being used in real-world settings. The uptake of telemental health has been very uneven geographically, and what explains this variation is also largely unknown. Our mixed-methods proposal centers on filling these gaps in knowledge. Under the first aim, we will conduct a series of descriptive analyses of data on 75 million adults with Medicare or commercial insurance to understand how telemental health is being used in conjunction with in-person care and whether the growth of telemental health has decreased disparities in the use of mental health specialists among disadvantaged populations. Under the second aim, we seek to explain why there is geographic variation in uptake using robust statistical machine learning. Under the third aim, we exploit the variation in uptake to assess whether communities with greater telemental health penetration have experienced improvements in care for patients with mental illness. In the fourth aim we will conduct qualitative interviews with providers to complement the empirical analyses and understand the key contextual factors underlying our findings. Understanding how telemental health is being used, why there is variation in use of telemental health, and whether telemental health use is associated with higher quality care could help drive future telemental health interventions and influence the ongoing policy debate on telemedicine regulations and reimbursement. Together the results of these aims are consistent with the NIMH's expressed interest in innovative delivery models that can improve care for underserved communities.