Understanding Use of Direct to Consumer Telemedicine for Pediatric Acute Respiratory Infections

了解直接面向消费者的远程医疗用于治疗小儿急性呼吸道感染

• 批准号: 10442750
• 负责人: Kristin N Ray
• 金额: $ 71.9万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10442750
• 关键词: Acute respiratory infection; Address; Adopted; Affect; Antibiotic Resistance; Antibiotics; Calculi; Caring; Child; Child Care; Childhood; Complement; Complex; Conflict (Psychology); Data; Decision Making; Decision Theory; Effectiveness; Electronic Health Record; Evaluation; Face; Family; Family health status; Foundations; Future; Goals; Health Care Costs; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Intervention; Interview; Knowledge; Methods; Modeling; Outpatients; Parents; Patients; Pattern; Patterns of Care; Policies; Policy Maker; Population; Process; Psyche structure; Public Health; Research; Safety; Sampling; Science; Service delivery model; Subgroup; Surveys; Telemedicine; Time; Treatment Side Effects; Viral; Viral Respiratory Tract Infection; Virus Diseases; Visit; acute care; base; care delivery; care outcomes; care seeking; cost; cost outcomes; experimental study; health care availability; improved; innovation; insight; novel; patient portal; preference; side effect; support tools; therapy design; tool; willingness

Pediatric acute respiratory infections (ARIs) account for over 30% of outpatient visits by young children and for over 50% of the outpatient visits that result in antibiotic prescriptions. Many ARIs are viral and self-limited, yet visits even for viral ARIs frequently result in unnecessary antibiotic use, leading to antibiotic resistance, treatment side effects, and health care spending exceeding $17 billion annually. As a result, efforts to limit unnecessary ARI visits and reduce unnecessary ARI antibiotic use are a high priority for the US health care system. These efforts face a new challenge in the emergence of direct-to-consumer (DTC) telemedicine as a care option for pediatric ARIs. By enabling access to care “anywhere, anytime,” DTC telemedicine offers improved timeliness and accessibility, but is also associated with increased volume of ARI visits and more unnecessary antibiotic use. With the new option of DTC telemedicine, parents must navigate several care options, each with potential gains and losses in quality domains relative to alternatives. Yet little is known about how parents approach tradeoffs in perceived quality in general and with DTC telemedicine specifically when making decisions about ARI care-seeking. The overall goal of this proposal is to address this critical knowledge gap by developing a comprehensive understanding of care-seeking decisions for pediatric ARIs in the context of DTC telemedicine. In Aim 1, we will use rigorous decision science methods to identify the “mental models” that parents use when making decisions about seeking care for a child’s ARI via DTC telemedicine versus other options. In Aim 2 we will employ robust quantitative methods to identify patient, family, and health system factors associated with use of DTC telemedicine for ARIs in national commercial claims data, complementing our micro-level examination of parent decision making with this macro-level examination of patterns of care. In Aim 3 we will examine parent tradeoff thresholds for specific attributes of acute care models through a discrete choice experiment. This aim will integrate the findings from our first two aims, asking parents to choose between pairs of care options with varying levels of key attributes (identified in Aim 1), allowing identification of preferences and willingness-to-trade thresholds for the full sample and for subgroups with differential use of DTC telemedicine for ARIs (identified in Aim 2). This project will apply rigorous decision science tools to DTC telemedicine, which is being rapidly adopted for pediatric ARIs without adequate understanding of its impact on care-seeking decisions. Together, these aims will provide critical insight into care- seeking decisions when priorities conflict (e.g., timeliness vs. safety) thereby informing future decision support tools, intervention design and evaluation, and payer and policy-maker decisions related to DTC telemedicine for pediatric ARIs.

小儿急性呼吸道感染（ARIS）占年轻的门诊就诊的30％以上 儿童以及超过50％的门诊就诊，导致抗生素处方。许多Aris是 病毒和自限制，但即使访问病毒式ARI经常会导致不必要的抗生素使用， 导致抗生素抵抗，治疗副作用和医疗保健支出超过170亿美元 结果，努力限制不必要的ARI访问并减少不必要的ARI抗生素 使用是美国医疗保健系统的高度优先事项。这些努力在 直接到消费者（DTC）远程医疗的出现是小儿ARIS的护理选择。通过启用 DTC远程医疗可以访问“任何地方，随时随地”，可提高及时性和可访问性， 但也与增加的ARI访问和更多不必要的抗生素使用有关。和 DTC远程医疗的新选择，父母必须浏览多种护理选项，每个选项都有潜力 相对于替代品的质量领域的收益和损失。然而，关于父母的方式知之甚少 在一般和DTC远程医疗方面，在 做出关于寻求Ari护理的决定。该提议的总体目标是解决这个关键 通过对小儿寻求护理决策的全面理解，知识差距 在DTC远程医疗的背景下。在AIM 1中，我们将使用严格的决策科学方法来 确定父母在做出决定照顾孩子时使用的“心理模型” ARI通过DTC远程医疗与其他选项。在AIM 2中，我们将采用强大的定量方法 确定与使用DTC远程医疗有关的患者，家庭和卫生系统因素 在国家商业索赔数据中，完成我们对父母决定的微观检查 通过对护理模式进行宏观检查。在AIM 3中，我们将检查父母的权衡 通过离散选择实验的急性护理模型特定属性的阈值。这个目标 将整合我们前两个目标的发现，要求父母在一对护理之间进行选择 具有不同级别的关键属性的选项（在AIM 1中标识），允许识别偏好 以及用于完整样本的意愿到贸易阈值，以及具有DTC差异使用的子组 ARIS的远程医疗（在AIM 2中确定）。该项目将应用严格的决策科学工具 DTC远程医疗，该远程医疗正在迅速用于小儿ARIS，但没有足够的了解 它对寻求护理决策的影响。这些目标一起将提供关怀的批判性见解 - 当优先级冲突（例如及时性与安全性）时，寻求决策，从而告知未来的决定 支持工具，干预设计和评估以及付款人和政策制定者的决定 DTC远程医疗用于小儿ARIS。