The Changing Landscape of Post-Acute Care and Health Outcomes for Older Adults

项目总结 新冠肺炎疫情对美国养老院造成了毁灭性打击。为回应这一事件 大流行构成了前所未有的威胁，联邦医疗保险要求SNF采取一系列措施 减少新冠肺炎的传播，包括禁止外部访问者进入。这一封锁的一个后果是 SNF提供护理服务的性质一夜之间发生了变化。具体地说，医疗保险放弃了长期以来的 围绕SNF住院医师评估的要求，包括为所有SNF提供新的灵活性 通过远程保健进行远程护理，以前仅限于特定条件下的农村社区卫生服务。 远程医疗长期以来一直被认为是为SNF提供护理服务的一项有前途的创新，其 居民有大量的医疗需求，行动不便。不幸的是，领养一直受到限制。这个 在SNF中使用远程医疗的障碍不是临床上的，而主要是错位的财务激励。远程医疗 需要在技术、培训和文化变革方面进行投资，但几乎没有额外的补偿。 新冠肺炎大流行极大地改变了SNF使用远程医疗的临床动机 鼓励医生提供这些服务的财政激励措施。 新冠肺炎出现后，人们对SNF是如何使用远程医疗的知之甚少。有很多 证据差距，例如了解SNF采用远程医疗的程度，哪些服务 通过虚拟护理提供，哪些类型的医生提供，以及哪些因素导致差异 远程医疗的使用。对这些问题的回答对于推进未来的报销政策和 这项技术在未来的SNF中的使用。 本K23附录的目的是描述远程医疗在SNF中的采用和使用情况 用于新冠肺炎的护理和非冠状病毒的临床护理。我的首要假设是，新冠肺炎 大流行极大地加速了远程医疗在SNF中的采用，用于新冠肺炎治疗和其他 临床护理，特别是在有新冠肺炎疫情的设施。我提出两个目标： 1)描述远程医疗对新冠肺炎治疗的采用和使用情况 根据患者、设施和地理特征的不同而变化。 2)描述具有不同远程医疗使用水平的SNF提供的所有非新冠肺炎临床护理的特点 在新冠肺炎大流行之前和期间。 这些目标将提供对SNF如何适应以下条件下的护理提供的详细见解 史无前例的情况。SNF采用远程医疗的证据可以为医疗保险的未来提供信息 监管、州和联邦对SNF远程医疗的投资以及未来支付政策的设计 新冠肺炎的浪潮。

PROJECT SUMMARY The COVID-19 pandemic has been devastating for nursing homes in the US. In response to the unprecedented threat posed by the pandemic, Medicare required SNFs to impose a number of measures to reduce the spread of COVID-19, including a ban on outside visitors. One consequence of this lockdown was an overnight transformation of the nature of care delivery in SNFs. Specifically, Medicare waived long-standing requirements around physician evaluation for SNF residents, including new flexibility for all SNFs to provide care remotely via telehealth, previously restricted to rural SNFs under specific conditions. Telemedicine has long been regarded as a promising innovation in care delivery for SNFs, whose residents have significant medical needs and impaired mobility. Unfortunately, adoption has been limited. The barriers to telemedicine use in SNFs are not clinical, but primarily misaligned financial incentives. Telemedicine requires investment in technology, training and culture change, but comes with little additional reimbursement. The COVID-19 pandemic dramatically changed the clinical motivation for SNFs to use telemedicine and the financial incentives for physicians to provide those services. Little is known about how SNFs have used telemedicine after COVID-19 emerged. There are many evidence gaps, such as understanding the extent of telemedicine adoption in SNFs, what services are delivered through virtual care, which sorts of physicians deliver them, and what factors contribute to variation in telemedicine use. Answers to these questions are necessary to advance policy for future reimbursement and use of this technology in SNFs moving forward. The objective of this K23 supplement is to characterize the adoption and use of telemedicine in SNFs for the care of COVID-19 and non-COVID clinical care. My overarching hypothesis is that the COVID-19 pandemic has vastly accelerated telemedicine adoption in SNFs for both COVID-19 treatment and other clinical care, especially at facilities with COVID-19 outbreaks. I propose two Aims: 1) Characterize the adoption and use of telemedicine for COVID-19 treatment in SNFs with COVID-19 cases and variation by patient, facility and geographic characteristics. 2) Characterize the delivery of all non-COVID-19 clinical care in SNFs with differing levels of telemedicine use before and during the COVID-19 pandemic. These Aims will provide detailed insight into how SNFs have adapted care delivery under unprecedented circumstances. Evidence on telemedicine adoption at SNFs can inform the future of Medicare regulation, state and federal investment in SNF telemedicine and the design of payment policy during future waves of COVID-19.