Clinical and Economic Impact of Teleneurology vs Standard in Clinic Care for Multiple Sclerosis: A Randomized Trial

远程神经学与多发性硬化症临床护理标准的临床和经济影响：随机试验

基本信息

批准号：
10710059
负责人：
Marisa McGinley
金额：
$ 51.23万
依托单位：
CLEVELAND CLINIC LERNER COM-CWRU
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：
2022-09-26 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10710059
关键词：
Absenteeism at work Academy Address Adherence Adult Affect American Automobile Driving COVID-19 pandemic California Caregiver Burden Caring Chronic Clinic Clinic Visits Clinical Communities Comprehensive Health Care Cost Effectiveness Analysis Data Diagnosis Digital biomarker Direct Costs Disease Dropout Emergency department visit Enrollment Ensure Equity Evaluation Face Facilities and Administrative Costs General Population Goals Health Health Care Costs Health Services Accessibility Healthcare Home Hospitalization Immune Improve Access Intervention Interview Knowledge Mediating Medical Methodology Methods Modality Modeling Multiple Sclerosis Neurologist Neurology Newly Diagnosed Outcome Outpatients Participant Patient Outcomes Assessments Patients Patterns of Care Perception Persons Pharmaceutical Preparations Policies Population Positioning Attribute Procedures Productivity Provider Quality of life Quality-Adjusted Life Years Randomized Recommendation Regulation Research Resources Sampling San Francisco Savings Schedule Secure Services Site Specialized Center Standardization Surveys System Testing Time Travel Universities Visit Work arm care costs care delivery central nervous system demyelinating disorder clinical care clinical trial participant cost cost comparison design disability economic impact experience follow-up health care delivery health care service utilization health related quality of life hospitalization rates improved insight multidisciplinary multiple sclerosis patient novel pilot trial preference randomized trial randomized, clinical trials satisfaction telehealth telehealthcare teleneurology theories two-arm study usability

项目摘要

PROJECT SUMMARY/ ABSTRACT Multiple sclerosis (MS) patients have higher healthcare utilization, reduced work productivity, reduced quality- adjusted life years, and lower health-related quality of life (QOL) relative to the general population. The current standard of outpatient MS care depends on in-clinic visits, but MS patients face many barriers to accessing this care. These barriers include those resulting from the disease itself, such as physical limitations, driving restrictions and financial limitations, and they are further compounded by an overall shortage of neurologists. Furthermore, MS care has a significant economic impact, with the estimated indirect and direct costs for treating MS in the US estimated to be > $48 billion. Therefore, there is a need to improve access to and reduce cost of MS care, and telehealth is a potential solution. Both our two multidisciplinary MS Centers (UCSF and Cleveland Clinic) have demonstrated that telehealth for MS care is feasible and that it results in travel savings for patients, reduction in missed work, and reduction in caregiver burden. Additionally, patient and provider satisfaction is high for this modality of care at the time of care delivery. These initial results are promising, but to date there are no studies assessing the longer-term impact of care delivery via telehealth on the Quadruple Aims of Healthcare: clinical care, cost, patient experience and clinician experience. The proposed study will directly bridge these research gaps in the longer-term impact of care delivery via telehealth. We will complete a two-Center trial, randomizing newly diagnosed MS patients to receive their routine MS care via telehealth or standard in-office care over 2 years. We will enroll 120 patients (assuming ~ 20% dropout rate for 100 completers), and will assess and compare standard clinical outcomes, patient-reported outcomes, costs, patient experience, and clinician care team experience associated with telehealth vs standard in clinic care. We will also conduct exit interviews with purposefully sampled trial participants to better identify facilitators and barriers to telehealth implementation. This study will generate needed evidence regarding the impact of telehealth on clinical outcomes, its cost, and stakeholder experience, and will inform clinical care implementation in other populations of MS patients and other chronic conditions.

项目摘要/摘要多发性硬化症（MS）患者的医疗保健利用率较高，工作生产率降低，质量降低 - 调整了生活年度，相对于一般人群，与健康相关的生活质量（QOL）较低。电流门诊MS Care的标准取决于临床访问，但MS患者面临许多障碍关心。这些障碍包括疾病本身的障碍，例如身体局限性，驾驶限制和财务局限性，神经科医生的总体短缺进一步加剧了它们。此外，Care女士对治疗的间接和直接成本具有重大的经济影响美国的MS估计为480亿美元。因此，有必要提高访问权限并降低成本 Care女士，远程医疗是一个潜在的解决方案。我们的两个多学科MS中心（UCSF和Cleveland 诊所表明，MS Care的远程医疗是可行的，它可以为患者节省旅行，减少缺席的工作和减轻照料者负担。此外，患者和提供者的满意度是在提供护理时，这种护理方式很高。这些最初的结果是有希望的，但是到目前为止没有研究通过远程医疗评估护理提供对医疗的四倍目标的长期影响：临床护理，成本，患者经验和临床医生经验。拟议的研究将直接弥合这些研究差距，以通过远程医疗。我们将完成一项两中心试验，随机对新诊断的MS患者进行随机接受以接受常规通过远程医疗或标准的办公室护理MS CARE 2年。我们将注册120名患者（假设约20％ 100个完成者的辍学率），并将评估和比较患者报告的标准临床结果与远程医疗相关的成果，成本，患者经验和临床医生护理团队的经验在诊所护理中。我们还将与有目的采样的试用参与者进行退出访谈，以更好地识别远程医疗实施的促进者和障碍。这项研究将为有关远程医疗对临床结果，成本和利益相关者的经验的影响，并将为临床护理提供信息在其他MS患者和其他慢性病的其他人群中实施。