Project 2: The Intersection of Telehealth and Health Disparities in At-Risk Older Patients with Cancer

项目 2：远程医疗与高危老年癌症患者健康差异的交叉点

• 批准号: 10762145
• 负责人: Melody K Schiaffino
• 金额: $ 24.45万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762145
• 关键词: Address; Adverse event; COVID-19 pandemic; California; Cancer Patient; Caring; Catchment Area; Cohort Studies; Communication; Complement; County; Data; Data Set; Databases; Development; Disparity; Elderly; Emergency department visit; Environment; Equity; Ethnic Origin; Future; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Household; Improve Access; Income; Individual; Inequality; Inequity; Internet; Intervention; Knowledge; Language; Link; Logistic Regressions; Low income; Malignant Neoplasms; Medicare; Medicare claim; Medicare/Medicaid; Methods; Modeling; Oncology; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Perception; Persons; Policies; Policy Maker; Population; Populations at Risk; Positioning Attribute; Provider; Quality of Care; Race; Research; Risk; Safety; Secondary to; Socioeconomic Status; Surveys; Technology; Telecommunications; Testing; Visit; Vulnerable Populations; access disparities; adverse outcome; anticancer research; beneficiary; cancer care; cancer education; cancer health disparity; cancer risk; care delivery; care outcomes; disparity reduction; ethnic minority; experience; health disparity; health equity; improved; interest; marginalized population; neoplasm registry; older patient; pandemic disease; patient population; patient-level barriers; population based; post-COVID-19; provider-level barriers; racial minority; response; telehealth

PROJECT SUMMARY/ ABSTRACT – PROJECT 2 Telehealth utilization increased rapidly across the US healthcare system in response to the COVID-19 pandemic. As we emerge from the pandemic, telehealth has become a new option for communication between patients and providers. Cancer care delivery appears well positioned to incorporate telehealth into the standard workflow of patient care. Furthermore, equitable implementation of telehealth could potentially increase access to care among vulnerable patients. However, emerging data suggest disparities with telehealth utilization access among non-White, low income, and non-English speaking individuals. Inequitable implementation of telehealth could inadvertently create barriers among our most vulnerable patients, which could paradoxically increase cancer health disparities. Large-scale rigorous research evaluating disparities in telehealth utilization within the post-COVID-19 cancer care environment is lacking. Furthermore, research has not addressed how telehealth utilization influences safety and quality of care compared to conventional in-person visits, particularly among our at-risk populations with higher baseline risks of poor outcomes and adverse events. Finally, a comprehensive understanding of telehealth disparities requires an understanding of patient perceptions and provider biases towards telehealth, which represent important unaddressed questions. To fill these critical knowledge gaps, we propose a comprehensive population-based cohort study among Medicare beneficiaries with cancer, incorporating linkages to secondary datasets providing data on providers, hospitals, and regional factors. We will assess the impact of telehealth on vulnerable cancer populations through the following aims: 1) identify and characterize disparities in telehealth during and after the COVID-19 pandemic; 2) assess the impact of telehealth on efficacy and safety of cancer delivery among at-risk populations; and 3) define actionable patient-level barriers and provider biases with telehealth utilization. This proposed study will help define the national landscape of telehealth among cancer patients, and will provide a framework for the development of future interventions to optimize telehealth among at-risk patients. This timely project will deliver actionable information to providers, healthcare systems, and policymakers. Overall, equitable, safe, and effective telehealth delivery stands to increase access to care and reduce cancer health disparities among our most vulnerable cancer patients.

项目摘要/摘要 - 项目2 在美国医疗系统中，远程医疗利用迅速增加了COVID-19 大流行。当我们从大流行中脱颖而出时，远程医疗已成为一种新的选择 病人和提供者。癌症护理的交付似乎很适合将远程医疗纳入标准 患者护理的工作流程。此外，远程医疗的公平实施可能会增加访问权限 在弱势患者中照顾。但是，新兴数据表明远程医疗利用的分布 非白人，低收入和非英语个人之间的访问。不平等的实施 远程医疗可能会无意间在我们最脆弱的患者中造成障碍，这可能是自相矛盾的 增加癌症健康分布。大规模的严格研究评估远程医疗利用中的分布 在CoVID后19日，缺乏癌症护理环境。此外，研究尚未解决 与传统的亲自访问相比，远程医疗利用会影响安全性和护理质量，特别是 在我们的高风险人群中，基线的结果较差和不良事件的风险。最后，一个 对远程医疗差异的全面理解需要了解患者的看法和 提供者对远程医疗有偏见，这代表了重要的未解决问题。填补这些关键 知识差距，我们提出了一项全面的基于人群的队列研究，对医疗保险受益人 使用癌症，将与辅助数据集结合在一起，提供有关提供者，医院和地区的数据 因素。我们将通过以下目的评估远程医疗对弱势癌症人群的影响：1） 识别和表征在19日大流行期间和之后远程医疗中的分布； 2）评估 远程医疗对处于危险人群中癌症的效率和安全性的影响； 3）定义 可操作的患者级别障碍和提供者的远程医疗利用偏见。这项拟议的研究将有助于 在癌症患者中定义远程医疗的国家景观，并将为 开发未来的干预措施，以优化高危患者的远程医疗。这个及时的项目将交付 提供给提供者，医疗保健系统和决策者的可行信息。总体，公平，安全，并且 有效的远程医疗交付将增加我们的护理机会并减少我们的癌症健康分布 最脆弱的癌症患者。