Telemedicine-Based Collaborative Care to Reduce Rural Health Disparities

基于远程医疗的协作护理减少农村健康差距

基本信息

批准号：
7462471
负责人：
JOHN C. FORTNEY
金额：
$ 59.71万
依托单位：
UNIV OF ARKANSAS FOR MED SCIS
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-09-21 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7462471
关键词：
Adherence Adoption American Antidepressive Agents Area Arkansas Arts Caring Chronic Chronic Care Chronic Disease Clinic Clinical Community Health Community Health Centers Computerized Medical Record Contracts Country Disease Educational workshop Effectiveness Electronic Health Record Emotional Engineering Evidence based practice Evidence based treatment Face Fasting Funding Future Goals Health Policy Health Services Accessibility Healthcare Healthcare Systems Individual Information Systems Internet Intervention Life Location Low income Medically Underserved Area Mental Depression Mental Health Mental Health Services Minority Mission Modeling Mood Disorders NIH Program Announcements National Institute of Mental Health Numbers Outcome Patient Access to Records Patients Physician Executives Policies Policy Maker Population Primary Health Care Principal Investigator Process Provider Public Health Publishing Randomized Controlled Clinical Trials Relative (related person)Reporting Research Research Infrastructure Research Personnel Resources Rest Risk Rural Rural Community Rural Health Rural Population Services Site Societies Specialist System Target Populations Technology Telemedicine Telephone Testing Translations United States Dept. of Health and Human Services United States Health Resources and Services Administration Veterans Visit base care delivery chronic care model collaborative care compare effectiveness cost cost effectiveness design experience health disparity health related quality of life improved innovation mental health center multidisciplinary novel organizational structure outreach portability preference programs rural area rural disparities satisfaction severe mental illness suicide rate technological innovation

项目摘要

DESCRIPTION (provided by applicant): Rural individuals with depression face substantial barriers to care, seldom receive evidence-based treatment, and experience poor outcomes. Collaborative care has been documented to improve outcomes in large urban Primary Care (PC) clinics. Implementing collaborative care in small rural practices presents a unique challenge because it is not feasible to employ on-site multidisciplinary care teams dedicated to depression treatment. No published studies have documented the effectiveness of collaborative care in small rural PC clinics. In fact, one recent collaborative care effectiveness study conducted in both rural and urban practices found that outcomes were significantly improved in urban clinics, but not rural clinics. Results from our current VA study demonstrate that telemedicine-based collaborative care is effective in small rural PC clinics. Telemedicine-based collaborative care was provided to rural clinics by an off-site depression care team using telephones, emails, interactive video, and a shared electronic medical record. A critical question for the field is whether it is more effective for small rural clinics to provide collaborative care services on-site (practice-based collaborative care model) or to contract with an off-site care team that specializes in providing collaborative care to multiple clinics from a centralized location using telemedicine technologies (telemedicine-based model). We propose to compare the effectiveness/cost-effectiveness of telemedicine-based collaborative care to practice-based collaborative care in six Community Health Center (CHC) systems in rural Arkansas. In 2003, 890 federally-funded CHCs served over 12 million poor, ethnically diverse patients living in medically underserved areas. CHCs are in the process of re-engineering clinics to provide practice-based collaborative care as a part of the Health Disparities Collaboratives. The proposed research has the potential to have a major public health impact because the results should be generalizable to the hundreds of rural CHCs across the country. CHCs represent one of the largest and fasting growing PC systems in the nation, and thus results should be applicable to a large number of providers and patients across the nation. In addition, CHCs serve predominantly low income minority populations living in medically underserved areas. This population is at high risk for experiencing health disparities and thus, interventions targeting this population have the potential to have a major impact.

描述（由申请人提供）：抑郁症患者面临着很大的护理障碍，很少接受循证治疗并经历不良的结果。已记录了协作护理，以改善大型城市初级保健（PC）诊所的结果。在小型农村实践中实施协作护理提出了一个独特的挑战，因为使用专门用于抑郁症治疗的现场多学科护理团队是不可行的。没有发表的研究记录了在小型农村PC诊所中协作护理的有效性。实际上，在农村和城市实践中进行的一项最近进行的合作护理有效性研究发现，在城市诊所的结果显着改善，但没有改善农村诊所。我们目前的VA研究结果表明，基于远程医疗的协作护理在小型农村PC诊所有效。一个基于远程医疗的协作护理是通过电话，电子邮件，交互式视频和共享电子病历的场外抑郁症护理团队向农村诊所提供的。该领域的一个关键问题是，对于小型农村诊所而言，在现场提供协作护理服务（基于实践的协作护理模型）还是与现场护理团队合同，该团队专门使用远程医疗技术（基于远程医疗的模型）从集中式位置提供合作护理的现场护理团队合同。我们建议将基于远程医疗的协作护理与在阿肯色州农村六个社区健康中心（CHC）系统中基于实践的协作护理的有效性/成本效益进行比较。 2003年，有890个联邦资助的CHC为生活在医学欠缺的地区的1200万贫困，种族多样的患者提供服务。 CHC正在重新设计诊所，以提供基于实践的协作护理作为健康差异协作的一部分。拟议的研究有可能对公共卫生产生重大影响，因为结果应推广到全国数百个农村卫生室。 CHC是全国最大，禁食的PC系统之一，因此结果应适用于全国大量提供者和患者。此外，CHC主要服务于居住在医学欠缺地区的低收入少数群体。该人群遇到健康差异的高风险，因此，针对该人群的干预措施有可能产生重大影响。