The Role of Virtual Care in Improving Primary Care Access and Continuity for At-Risk Multimorbid Older Adults

虚拟护理在改善高危多病老年人的初级护理获取和连续性方面的作用

基本信息

批准号：
10378020
负责人：
Ishani Ganguli
金额：
$ 16.82万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10378020
关键词：
Address Adult Affect Aging Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Ambulatory Care Award COVID-19 pandemic COVID-19 pandemic effects Caring Chronic Clinical Continuity of Patient Care Data Data Analyses Drops Elderly Electronic Health Record Evaluation Fee-for-Service Plans Future Geriatrics Goals Health Health Services Health Services Accessibility Health Services Research Health system Hospitalization Hospitals Improve Access Incentives Insurance Claim Review Internet Knowledge Link Low income Measures Medicare Medicare claim Medicine Memory Mentored Patient-Oriented Research Career Development Award Mentorship Methods Minority Modeling Office Visits Organizational Models Outcome Patients Policies Population Primary Care Physician Primary Health Care Quality of Care Race Reporting Research Research Personnel Risk Risk Factors Role Secure Surveys Telephone Touch sensation Training Visit Woman Work base beneficiary care delivery care outcomes care providers career cost experience human old age (65+)improved improved outcome indexing innovation medical schools multiple chronic conditions novel pandemic disease payment primary care setting professor social video visit virtual virtual delivery virtual healthcare

项目摘要

Project Summary/Abstract This K23 award will establish Ishani Ganguli MD, MPH as a clinician-investigator focused on how care delivery and payment innovation can advance high-value outpatient care and better outcomes for older adults. Dr. Ganguli is an Assistant Professor of Medicine and primary care physician at Harvard Medical School and Brigham and Women’s Hospital. Building on her clinical training, methods coursework, and experiences studying care innovation and leading it at an Accountable Care Organization (ACO), this award will allow her to develop expertise in (1) how aging needs, especially for those with multimorbidity and Alzheimer’s Disease (AD) and AD-related dementias (AD/ADRD), can be met through outpatient care innovation, (2) advanced quantitative methods, and (3) claims-linked electronic health record (EHR) data analysis. To achieve these goals, Dr. Ganguli has assembled a team with expertise in health services research on care innovation (Drs. Ateev Mehrotra, Thomas Sequist), geriatrics (Dr. Christine Ritchie), primary care (Drs. Meredith Rosenthal, Joshua Metlay), quantitative methods (Drs. E. John Orav, J. Michael McWilliams, Craig Pollack), and EHR data analysis (Dr. Christine Vogeli). Primary care access and continuity of care improve outcomes for multimorbid older adults, so a recent decline in primary care office visit rates – likely due in part to barriers attending these visits – raises concerns. Virtual care may enable access and continuity. But we do not know which groups faced office visit barriers pre-dating the Covid-19 pandemic nor how post- pandemic expansion of virtual care will affect primary care access or continuity for these groups. To address these critical questions, Dr. Ganguli will first use the claims-linked Medicare Current Beneficiary Survey to describe visit use and visit continuity of care (COC) associated with reported trouble getting to the doctor’s office and whether adults with AD/ADRD or social risk factors were at greater risk of this barrier (Aim 1). In Aim 2, using difference-in-differences analysis of claims-linked EHR data in a large Medicare ACO, she will assess how post- pandemic expansion of virtual care affects primary care use in these populations. In Aim 3, she will use these claims-linked EHR data to develop a novel application of the COC measure (“touch continuity,” which includes virtual care) and determine if it is associated with risk of preventable hospitalizations. This work and training will provide the basis for a future R01 proposal of a quasi-experimental, multi-health system study of virtual primary care for multimorbid older adults. This K23 award and future R01 will inform how to pay for and deliver virtual care to promote high-value outpatient care and better outcomes for older adults.

项目概要/摘要该 K23 奖项将确立 Ishani Ganguli 医学博士、公共卫生硕士作为一名专注于护理服务和支付创新如何促进高价值门诊护理并更好地提供服务 Ganguli 博士是医学和初级保健助理教授。哈佛医学院和布莱根妇女医院的医生以她为基础。临床培训、方法课程以及学习护理创新和领导的经验在责任医疗组织 (ACO) 工作，该奖项将使她能够在 (1) 方面发展专业知识老龄化的需求，尤其是那些患有多种疾病和阿尔茨海默氏病 (AD) 的人，以及 AD 相关痴呆 (AD/ADRD)，可以通过门诊护理创新来解决，(2) 先进定量方法，(3) 与索赔相关的电子健康记录 (EHR) 数据分析。为了实现这些目标，甘古利博士组建了一支具有卫生服务专业知识的团队护理创新研究（Ateev Mehrotra 博士、Thomas Sequist）、老年医学（Christine 博士） Ritchie）、初级保健（Meredith Rosenthal 博士、Joshua Metlay 博士）、定量方法（E. Ritchie 博士） John Orav、J. Michael McWilliams、Craig Pollack）和 EHR 数据分析（Christine Vogeli 博士）。初级保健的获取和护理的连续性可改善多病老年人的治疗结果，因此最近初级保健办公室就诊率下降——可能部分是由于克服了这些障碍访问 – 引起担忧虚拟护理可能会实现访问和连续性。哪些群体在 Covid-19 大流行之前面临办公室访问障碍，以及在 Covid-19 大流行之后如何面临办公室访问障碍虚拟护理的大流行扩张将影响这些群体的初级护理获取或连续性。为了解决这些关键问题，Ganguli 博士将首先使用与索赔相关的 Medicare Current 受益人调查，描述与以下相关的就诊使用情况和就诊连续性护理 (COC) 报告说去医生办公室有困难，以及是否患有 AD/ADRD 或社会风险的成年人因素面临这种障碍的风险更大（目标 1），在目标 2 中，使用双重差分法。在分析大型 Medicare ACO 中与索赔相关的 EHR 数据时，她将评估事后如何在目标 3 中，虚拟护理的流行扩张影响了这些人群的初级护理使用。将使用这些与索赔相关的 EHR 数据来开发 COC 措施的新颖应用（“触摸连续性”，包括虚拟护理）并确定它是否与以下风险相关：这项工作和培训将为未来的 R01 奠定基础。关于虚拟初级保健的准实验性、多卫生系统研究的提案该 K23 奖项和未来的 R01 将告知如何支付和交付。虚拟护理可促进高价值门诊护理并为老年人提供更好的治疗结果。