Provision of high quality telemental health care during COVID-19 and beyond

在 COVID-19 期间及之后提供高质量的远程医疗保健

• 批准号: 10532428
• 负责人: Samantha L Connolly
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2027-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10532428
• 关键词: Academy; Address; Anxiety; Appointment; Attitude; COVID-19; COVID-19 pandemic; Caring; Clinic; Clinical; Clinical Services; Collaborations; Comparative Effectiveness Research; Complex; Data; Decision Making; Development; Diagnosis; Effectiveness; Ensure; Future; Goals; Health Services; Health Services Accessibility; Health Technology; Healthcare; Home; Hospitalization; Hybrids; Infection; Infection prevention; Interview; Leadership; Medication Management; Medicine; Mental Health; Mental Health Services; Mentors; Methodology; Methods; Modality; Outcome; Outpatients; Patient Care; Patient Preferences; Patients; Persons; Positioning Attribute; Process; Provider; Psychologist; Psychotherapy; Publishing; Quality of Care; Recording of previous events; Research; Research Personnel; Research Priority; Safety; Sampling; Scientist; Services; Site; Suicide prevention; Symptoms; System; Telemental; Telephone; Testing; Time; Training; Travel; Veterans; Videoconferencing; Work; authority; base; caregiving; comparative effectiveness; connected care; coronavirus disease; cost; design; effectiveness implementation study; effectiveness implementation trial; effectiveness trial; evidence base; experience; health care delivery; hospitalization rates; implementation strategy; improved; infection risk; innovation; pandemic disease; preference; prevent; primary care services; social stigma; telehealth; Academy; Address; Anxiety; Appointment; Attitude; COVID-19; COVID-19 pandemic; Caring; Clinic; Clinical; Clinical Services; Collaborations; Comparative Effectiveness Research; Complex; Data; Decision Making; Development; Diagnosis; Effectiveness; Ensure; Future; Goals; Health Services; Health Services Accessibility; Health Technology; Healthcare; Home; Hospitalization; Hybrids; Infection; Infection prevention; Interview; Leadership; Medication Management; Medicine; Mental Health; Mental Health Services; Mentors; Methodology; Methods; Modality; Outcome; Outpatients; Patient Care; Patient Preferences; Patients; Persons; Positioning Attribute; Process; Provider; Psychologist; Psychotherapy; Publishing; Quality of Care; Recording of previous events; Research; Research Personnel; Research Priority; Safety; Sampling; Scientist; Services; Site; Suicide prevention; Symptoms; System; Telemental; Telephone; Testing; Time; Training; Travel; Veterans; Videoconferencing; Work; authority; base; caregiving; comparative effectiveness; connected care; coronavirus disease; cost; design; effectiveness implementation study; effectiveness implementation trial; effectiveness trial; evidence base; experience; health care delivery; hospitalization rates; implementation strategy; improved; infection risk; innovation; pandemic disease; preference; prevent; primary care services; social stigma; telehealth

Background: Telemental health (TMH) via videoconferencing or phone can increase Veterans’ access to mental health (MH) care. TMH can eliminate barriers including travel distance and cost, as well as physical limitations, caregiving responsibilities, and MH symptoms that can make leaving home difficult. Prior to COVID- 19, rates of TMH in VA were low (~9%). There was a dramatic shift towards TMH during COVID-19 to prevent infection, with ~50% of care delivered by phone, ~25% by video, and ~25% in-person. Benefits and drawbacks of phone, video, and in-person care must be considered when choosing a MH care modality. If patients, providers, and/or leadership believe that phone care is equivalent in quality to video and/or in-person, they may be more likely to choose this modality as it often has the fewest barriers to use; however, based on limited evidence, phone care may be lower quality than video and in-person. We need more nuanced analyses regarding: 1) the relative quality of phone, video, and in-person care (e.g., for more complex patients, for psychotherapy sessions versus shorter medication management appointments), and 2) patient preferences. As a clinical psychologist and HSR&D investigator with TMH experience, I am well-positioned to conduct this research. This proposal will provide key methodological training and advance me toward my goal of becoming a leading health services researcher and implementation scientist with expertise in telehealth. Significance/Impact: MH, telehealth, access, and quality of care are all major HSR&D research priorities. The increased use of TMH during COVID-19 has led to a wealth of untapped data through which we can examine the relative quality of TMH care as well as patient preferences across modalities, in order to improve care modality decision-making processes. Results, which will incorporate data from millions of patients and thousands of providers, have the potential to impact delivery of high-quality MH care on a national scale. Innovation: To our knowledge, there has been no published research that: 1) compares the quality and patient preference of phone, video, and in-person MH care, and 2) uses this information to develop and implement evidenced-based strategies to increase video use when clinically effective and preferred by patients. Specific Aims: Aim 1: Examine quality outcomes of phone, video, and in-person MH care (e.g., differences in MH hospitalization rates). Hypothesis: Video care will be equivalent to in-person care and superior to phone care for more complex patients (e.g., history of MH hospitalization, 3+ MH diagnoses) and for psychotherapy appointments. Aim 2: Qualitative interviews with MH patients, providers, and leadership. Research question: What are facilitators/barriers to video use based on stakeholder attitudes, preferences, and decision-making processes, and how do these factors vary between sites with high levels of phone, video, and in-person care? Aim 3: Develop/pilot implementation strategies to increase video use in circumstances where it is clinically effective and preferred by patients. Hypothesis: Implementation strategies will increase video use. Methodology: In Aim 1, I will test for differences in quality outcomes between modalities via a sample of ~2 million Veterans who received MH care between 3/2020-3/2021 using comparative effectiveness research strategies. In Aim 2, I will conduct interviews with key stakeholders to understand facilitators and barriers to video use based on attitudes, preferences and current decision-making processes. In Aim 3, I will synthesize Aim 1 and 2 findings to develop and pilot implementation strategies at one VISN 1 MH site to increase video use in circumstances where it is clinically effective and preferred by patients. Strategies will be targeted at the patient, provider, and/or system levels based on Aim 1 and 2 findings. Next Steps/Implementation: The piloted strategies will be spread to additional MH sites, and ultimately other clinical services, via hybrid implementation-effectiveness trials in subsequent IIRs. Findings will be communicated to MH and Connected Care operational partners to inform the future of VA MH care delivery.

背景：通过视频会议或电话伸缩健康（TMH）可以增加退伍军人的访问权限 心理健康（MH）护理。 TMH可以消除包括旅行距离和成本在内的障碍以及物理 限制，护理责任和MH符号可能会使离开家困难。在covid-之前 19，VA中的TMH速率较低（〜9％）。在Covid-19期间，向TMH发生了巨大的转变，以防止 感染，通过电话提供的约50％的护理，通过视频约25％，面对面约25％。好处和缺点 选择MH护理方式时，必须考虑电话，视频和面对面的护理。如果患者， 提供者和/或领导人认为，电话护理的质量等效于视频和/或面对面的人，他们可能会 更有可能选择这种方式，因为它通常使用最少的障碍；但是，基于有限 证据，电话护理可能比视频和面对面的质量低。我们需要更多细微的分析 关于：1）电话，视频和面对面护理的相对质量（例如，对于更复杂的患者， 心理治疗课程与较短的药物管理任命）以及2）患者偏好。作为 我的TMH经验的临床心理学家和HSR＆D调查员，我很容易进行此操作 研究。该建议将提供关键的方法论培训，并促进我的目标 一位领先的卫生服务研究人员和实施科学家，具有远程医疗专业知识。 意义/影响力：MH，远程医疗，访问和护理质量都是HSR＆D研究的重点。这 Covid-19期间TMH的使用增加导致了大量未开发的数据，我们可以通过这些数据进行检查 为了改善护理，TMH护理的相对质量以及患者偏好 模式决策过程。结果，将结合数百万患者的数据， 成千上万的提供商有可能在全国范围内影响高质量MH护理的交付。 创新：据我们所知，没有发表的研究：1）比较质量和患者 偏爱电话，视频和面对面的MH护理，以及2）使用此信息来开发和实施 有证据的策略在临床上有效并受到患者的首选时增加视频使用的策略。 具体目的：目标1：检查电话，视频和面对面MH护理的质量结果（例如 MH住院率）。假设：视频护理将等效于面对面的护理，并且优于电话 护理更复杂的患者（例如，MH住院病史，3 MH诊断）和心理治疗 约会。目标2：与MH患者，提供者和领导者的定性访谈。研究问题： 基于利益相关者的促进者/视频使用障碍是什么 流程，这些因素在高水平的电话，视频和面对面护理的网站之间如何有所不同？ 目标3：制定/试点实施策略以在临床上增加视频的使用来增加视频的使用 有效并受到患者的喜好。假设：实施策略将增加视频使用。 方法论：在AIM 1中，我将通过〜2样本测试模式之间质量结果的差异 使用比较有效性研究在3/2020-3/2021之间获得MH护理的百万退伍军人 策略。在AIM 2中，我将对主要利益相关者进行采访，以了解促进者和障碍 根据与会者，偏好和当前决策过程的视频使用。在AIM 3中，我将合成 目标1和2的发现，以在一个VISN 1 MH网站上制定和试行实施策略以增加视频 在临床有效且受到患者首选的情况下使用。策略将针对 患者，提供商和/或系统级别基于AIM 1和2的发现。 下一步/实施：试验策略将传播到其他MH站点，最终将 临床服务，通过随后的IIR中的混合实施效应试验。发现将是 传达给MH和连接的护理运营伙伴，以告知VA MH护理交付的未来。