Impact of Telemedicine on Medicare Beneficiaries with Mental Illness

远程医疗对患有精神疾病的医疗保险受益人的影响

基本信息

批准号：
10063830
负责人：
Ateev Mehrotra
金额：
$ 64.32万
依托单位：
HARVARD MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-12-01 至 2022-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10063830
关键词：
Address Adult Affect Area Automobile Driving Caring Clinical Clinical Trials Communities Complement Congresses Data Data Analyses Diffusion Disabled Persons Emergency department visit Evaluation Future Geography Growth Health Personnel Health Services Accessibility Health system Hospitalization Improve Access Insurance Internet Intervention Interview Knowledge Laws Literature Low income Medicaid Medicare Mental Depression Mental Health Mental disorders Methods Modeling National Institute of Mental Health Outcome Patient Care Patients Pattern Penetration Persons Policies Population Provider Psyche structure Psychotic Disorders Quality of Care Randomized Regulation Research Rural Rural Community Sampling Schizophrenia Series Specialist Speed Structure Telemedicine Telemental Testing Training Variant Videoconferencing Visit Work base beneficiary care costs contextual factors control trial demographics design disadvantaged population experience geographic difference improved improved outcome innovation interest machine learning method medical specialties medication compliance older patient population health programs racial and ethnic disparities rapid growth rural area severe mental illness statistical and machine learning trend trial comparing underserved community uptake

项目摘要

PROJECT SUMMARY Access to mental health specialists is difficult for many patients in the U.S., particularly for the poor and those who live in rural communities. Telemental health is one potential solution for this access problem, and there has been rapid growth in the number of live video-based telemental health visits in the U.S. While there are numerous rigorous randomized-control trials comparing telemental health visits to in-person mental health specialist care, there have been little research on how telemental health is being used in real-world settings. The uptake of telemental health has been very uneven geographically, and what explains this variation is also largely unknown. Our mixed-methods proposal centers on filling these gaps in knowledge. Under the first aim, we will conduct a series of descriptive analyses of data on 75 million adults with Medicare or commercial insurance to understand how telemental health is being used in conjunction with in-person care and whether the growth of telemental health has decreased disparities in the use of mental health specialists among disadvantaged populations. Under the second aim, we seek to explain why there is geographic variation in uptake using robust statistical machine learning. Under the third aim, we exploit the variation in uptake to assess whether communities with greater telemental health penetration have experienced improvements in care for patients with mental illness. In the fourth aim we will conduct qualitative interviews with providers to complement the empirical analyses and understand the key contextual factors underlying our findings. Understanding how telemental health is being used, why there is variation in use of telemental health, and whether telemental health use is associated with higher quality care could help drive future telemental health interventions and influence the ongoing policy debate on telemedicine regulations and reimbursement. Together the results of these aims are consistent with the NIMH's expressed interest in innovative delivery models that can improve care for underserved communities.

项目概要对于美国的许多患者来说，获得心理健康专家的帮助很困难，特别是对于穷人和那些居住在农村社区的人。远程心理健康是解决这一访问问题的一种潜在解决方案，并且在美国，基于实时视频的远程心理健康就诊的数量一直在快速增长。许多严格的随机对照试验将远程心理健康访问与面对面的心理健康进行比较专家护理方面，关于如何在现实环境中使用远程心理健康的研究很少。远程心理健康的接受程度在地理上非常不均匀，解释这种差异的原因也在于很大程度上不为人知。我们的混合方法提案的重点是填补这些知识空白。根据第一个目标，我们将对 7500 万医疗保险成年人的数据进行一系列描述性分析或商业保险，以了解远程心理健康如何与面对面护理结合使用以及远程心理健康的发展是否减少了心理健康专家的使用差异弱势群体之中。在第二个目标下，我们试图解释为什么存在地理差异使用强大的统计机器学习来吸收。在第三个目标下，我们利用吸收的变化来评估远程心理健康普及率较高的社区在以下方面是否有所改善照顾精神疾病患者。在第四个目标中，我们将与提供商进行定性访谈，以补充实证分析并了解我们研究结果背后的关键背景因素。了解如何使用远程心理健康、为什么远程心理健康的使用存在差异，以及远程心理健康的使用是否与更高质量的护理相关可以帮助推动未来的远程心理健康干预措施并影响正在进行的有关远程医疗法规和报销的政策辩论。这些目标的结果与 NIMH 对创新交付所表达的兴趣是一致的可以改善服务欠缺社区的护理的模型。