Health Services Utilization During the COVID-19 Pandemic

COVID-19 大流行期间卫生服务的利用

基本信息

批准号：
10446307
负责人：
Christopher Whaley
金额：
$ 48.15万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-30 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10446307
关键词：
Adopted Adoption Affect Businesses COVID-19 COVID-19 disparity COVID-19 pandemic COVID-19 pandemic effects COVID-19 patient COVID-19 vaccination Cantor Caring Centers of Research Excellence Characteristics Clinical Continuity of Patient Care County Data Data Set Elderly Ensure Face Fee-for-Service Plans Financial Hardship Financial Support Funding Health Health Services Health Services Accessibility Health system Healthcare Systems Home Lead Low income Measures Medicare Modality Natural experiment Operative Surgical Procedures Organizational Change Outcome Patient Care Patient-Focused Outcomes Patients Pattern Patterns of Care Performance Persons Physicians Policies Population Positioning Attribute Privatization Procedures Provider Publishing Quality of Care Research Personnel Resources Risk Factors Running Rural Services Shock Social Distance System Technology Telemedicine Travel United States United States Agency for Healthcare Research and Quality United States Centers for Medicare and Medicaid Services Variant Visit Work care delivery care outcomes coronavirus disease design ethnic minority population experience health care delivery health care disparity health care service utilization health service use improved medical vulnerability multiple chronic conditions organizational structure pandemic disease patient population patient subsets payment provider adoption public health emergency racial and ethnic racial minority resilience response social social vulnerability telehealth

项目摘要

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic has created an unprecedented shock to the U.S. health care system and to care delivery for patients. As documented by the study team, the COVID-19 pandemic suddenly and dramatically changed health care utilization patterns, including a rapid escalation in use of telehealth services, an abrupt decline in in-person services, and a large volume of deferred services. It is unclear how these care patterns will evolve over the course of the pandemic (e.g., the degree to which deferred services will occur later, telehealth will substitute for in-person services, and new levels of telehealth services will be sustained), much less in the years following the COVID-19 pandemic, and how continuing care patterns will differ for socially and clinically vulnerable patient populations. Physician organizations (POs) face differing burdens in rapidly adopting telemedicine, and PO barriers to telemedicine adoption may be reflected in the outcomes of patients treated by these POs. The reduction in in-person care has placed financial stress on many POs, leading to concerns that many POs may go out of business or consolidate. The impacts of care reductions, the adoption of telemedicine as a new care delivery modality, and access to POs are likely to have larger effects among vulnerable patient populations, including lower-income, rural, and racial/ethnic minority populations, and patients with multiple chronic conditions. Understanding patient and provider responses to the COVID-19 public health crisis and the care patients receive, particularly those who are medically and socially vulnerable, is essential to inform immediate-term and longer-term policymaking intended to help the health delivery system respond to COVID- 19. We propose to conduct a set of analyses to 1) Estimate how health services have changed during the COVID-19 pandemic, the factors associated with changes in health service use, if health delayed care remains unmet once the COVID-19 pandemic subsides, how policy responses (social distancing policies and COVID- 19 vaccination) have impacted care delivery, and how these patterns differ for medically and socially vulnerable patient populations; 2) Asses PO barriers to adopting telemedicine and assess if PO adoption of telemedicine lessens adverse health outcomes, particularly among vulnerable patient populations; and 3) Examine if PO closure or consolidation due to COVID-19 leads to gaps in patient care continuity or access barriers among vulnerable patient populations. To do so, we will leverage the existing data assets and expertise of the RAND U19 Center of Excellence that the research team has built over the past 5 years. We will use 100% Medicare fee-for-service claims data. Findings from this study will help inform an array of immediate-term and longer-term policies and regulatory changes, including changes to payment policies, use of technology, financial assistance to providers to ensure their survival, and improving the ability of health systems to respond to how the COVID-19 pandemic has reshaped the US health care system.

项目概要/摘要 COVID-19 大流行对美国医疗保健系统和护理人员造成了前所未有的冲击为患者送货。正如研究小组所记录的那样，COVID-19 大流行突然而剧烈改变了医疗保健利用模式，包括远程医疗服务的使用迅速升级、突然的面对面服务减少，以及大量延期服务。目前尚不清楚这些护理模式将如何在大流行期间不断演变（例如，延迟服务的发生程度、远程医疗将取代面对面的服务，并且将维持新水平的远程医疗服务），更不用说在 COVID-19 大流行后的几年，以及持续护理模式在社会和临床方面将有何不同弱势患者群体。医生组织 (PO) 在快速采用新技术方面面临着不同的负担远程医疗和 PO 阻碍远程医疗采用的障碍可能会反映在接受远程医疗治疗的患者的结果中这些 PO。面对面护理的减少给许多 PO 带来了财务压力，导致人们担心许多采购订单可能会倒闭或合并。护理减少、远程医疗采用的影响作为一种新的护理提供方式，获得 PO 可能会对弱势患者产生更大的影响人群，包括低收入、农村和少数种族/族裔人群，以及患有多种疾病的患者慢性病。了解患者和提供者对 COVID-19 公共卫生危机的反应以及患者接受的护理，特别是那些在医疗和社会上处于弱势的患者，必须告知他们旨在帮助卫生服务系统应对新冠肺炎的近期和长期政策制定 19. 我们建议进行一系列分析，以 1) 估计卫生服务在 COVID-19 大流行，如果医疗延迟护理仍然存在，则与医疗服务使用变化相关的因素一旦 COVID-19 大流行消退，政策应对措施（社交距离政策和 COVID-19 政策）将如何解决？ 19 疫苗接种）影响了护理服务，以及这些模式在医疗和社会方面有何不同弱势患者群体； 2) 评估 PO 采用远程医疗的障碍，并评估 PO 采用是否远程医疗可减少不良健康后果，特别是弱势患者群体；和 3) 检查因 COVID-19 导致 PO 关闭或合并是否会导致患者护理连续性或访问方面的差距弱势患者群体中的障碍。为此，我们将利用现有的数据资产研究团队在过去 5 年里建立的兰德 U19 卓越中心的专业知识。我们将使用 100% Medicare 按服务收费的索赔数据。这项研究的结果将有助于为一系列问题提供信息近期和长期政策和监管变化，包括支付政策的变化、使用技术、向提供者提供财政援助以确保其生存并提高健康能力系统来应对 COVID-19 大流行如何重塑美国医疗保健系统。