The Use of Telemedicine in the Care of Nursing Home Residents with Alzheimer's Disease and Related Dementias During and After the COVID-19 Pandemic

在 COVID-19 大流行期间和之后使用远程医疗来护理患有阿尔茨海默病和相关痴呆症的疗养院居民

• 批准号: 10345587
• 负责人: Michael Lawrence Barnett
• 金额: $ 46.18万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10345587
• 关键词: Accident and Emergency department; Address; Administrator; Adopted; Adoption; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease related dementia; American; Area; COVID-19; COVID-19 pandemic; Caring; Cessation of life; Characteristics; Clinical; Data; Data Set; Dementia; Diagnosis; Drops; Elderly; Emergency department visit; Geriatric Psychiatry; Goals; Health; Healthcare; Home Nursing Care; Hospitalization; Hour; Individual; Knowledge; Leadership; Literature; Logistics; Measures; Medicaid; Medical; Medicare; Medicare claim; Mission; Modeling; Neurology; Nursing Homes; Outcome; Patient Transfer; Patients; Pattern; Perception; Personal Satisfaction; Persons; Physician Executives; Physicians; Policies; Population; Provider; Psychiatry; Reporting; Rural; Sampling; Services; Skilled Nursing Facilities; Surveys; Telemedicine; Vaccines; Visit; Vulnerable Populations; base; coronavirus disease; cost; disadvantaged population; hospitalization rates; implementation barriers; implementation strategy; improved; improved outcome; innovation; medical specialties; novel coronavirus; pandemic disease; programs

The Use of Telemedicine in the Care of Nursing Home Residents with Alzheimer's Disease and Related Dementias During and After the COVID-19 Pandemic PROJECT SUMMARY The novel coronavirus disease 2019 (COVID-19) pandemic has devastated nursing home residents in the US, nearly half of whom are diagnosed with Alzheimer's and other related dementias (ADRD). To limit resident exposure and expand safe access to desperately-needed care from physicians and advanced practice providers, Medicare dropped previously tight restrictions and temporarily allowed SNFs to broadly use telemedicine to obtain care for residents. Dropping these restrictions helped facilitate a rapid adoption of telemedicine in SNFs, from <1% of SNFs billing for any telemedicine services in Oct-Dec 2019 to 55% in Apr- May 2020. Telemedicine has long been regarded as a promising, but underused, delivery innovation for SNFs addressing two major gaps in care. First, SNF clinicians are not always onsite, so medical issues that present during off-hours are often addressed by transferring patients, often unnecessarily, to the emergency department. Second, due to both financial and logistic reasons it is very difficult for SNF residents to obtain specialty care, including specialties critical those with ADRD like neurology or psychiatry. A limited literature suggests that telemedicine can bridge both of these care gaps, but more rigorous evidence is needed. In 2021, understanding the adoption and clinical impact of SNF telemedicine for the vulnerable population of older adults with ADRD has new urgency. We propose to use Medicare claims, the Minimum Data Set and a national survey on SNF telemedicine implementation to answer the following specific aims: 1) Evaluate the patient-level association of SNF adoption of telemedicine in 2020 with health care use and clinical outcomes (COVID-19 and non-COVID-19) for SNF residents with and without ADRD. 2) Use group-based trajectory models to characterize 2020-2021 SNF-level patterns of telemedicine use (e.g., sustaining vs. de-adopting) and SNF characteristics associated with different trajectories. 3) Survey a national sample of SNFs, stratified by their trajectories measured in Aim 2, to assess facility leadership perceptions of telemedicine use and telemedicine implementation strategies. Understanding how SNFs have used telemedicine and its association with clinical outcomes is essential to inform how Medicare and state Medicaid programs should regulate and promote telemedicine use in SNFs. Our findings will also help guide clinicians who care for SNF residents with ADRD on the clinical impact associated with telemedicine use and how it is being used nationally.

远程医疗在护理患有阿尔茨海默病及相关疾病的疗养院居民中的应用 COVID-19 大流行期间和之后的痴呆症 项目概要 2019 年新型冠状病毒病 (COVID-19) 大流行给疗养院居民带来了沉重打击 在美国，近一半的人被诊断患有阿尔茨海默病和其他相关痴呆症（ADRD）。限制 居民接触并扩大从医生和先进实践中安全获得急需护理的机会 医疗保险放弃了之前严格的限制，暂时允许 SNF 广泛使用 远程医疗为居民提供护理。放弃这些限制有助于促进快速采用 SNF 中的远程医疗，从 2019 年 10 月至 12 月任何远程医疗服务费用占 SNF 的不到 1% 到 4 月的 55% 2020 年 5 月。 远程医疗长期以来一直被认为是一种有前途但未得到充分利用的 SNF 交付创新 解决护理方面的两个主要差距。首先，SNF 临床医生并不总是在现场，因此出现的医疗问题 在非工作时间，通常通过将患者转移到急诊室来解决，这通常是不必要的 部门。其次，由于资金和后勤方面的原因，SNF居民很难获得 专科护理，包括对 ADRD 患者至关重要的专科，如神经病学或精神病学。文献有限 表明远程医疗可以弥补这两个护理差距，但需要更严格的证据。 2021 年，了解 SNF 远程医疗对弱势群体的采用和临床影响 患有 ADRD 的老年人群面临着新的紧迫性。我们建议使用医疗保险索赔，最低 关于 SNF 远程医疗实施的数据集和全国调查，旨在回答以下具体目标： 1) 评估 2020 年 SNF 采用远程医疗与医疗保健使用的患者层面关联性 患有或不患有 ADRD 的 SNF 居民的临床结果（COVID-19 和非 COVID-19）。 2) 使用基于群体的轨迹模型来描述 2020-2021 年远程医疗使用的 SNF 级别模式（例如， 维持与取消采用）以及与不同轨迹相关的 SNF 特征。 3) 调查全国 SNF 样本，根据目标 2 中测量的轨迹进行分层，以评估设施 领导层对远程医疗使用和远程医疗实施策略的看法。 了解 SNF 如何使用远程医疗及其与临床结果的关联是 对于告知医疗保险和州医疗补助计划应如何规范和促进远程医疗的使用至关重要 在 SNF 中。我们的研究结果还将有助于指导护理患有 ADRD 的 SNF 居民的临床医生 与远程医疗使用相关的影响以及远程医疗在全国的使用方式。