Access, Utilization and Outcomes of Cancer Services in the Era of Telemedicine

远程医疗时代癌症服务的获取、利用和结果

基本信息

批准号：
10559541
负责人：
Tracy Onega
金额：
$ 35.47万
依托单位：
UNIVERSITY OF UTAH
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：
2022-02-01 至 2027-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10559541
关键词：
Address Adoption American Area Automobile Driving Black race Bladder Breast COVID-19 pandemic Cancer Patient Catchment Area Censuses Clinical Colon Communication Data Dimensions Emergency department visit Equity Fee-for-Service Plans Geographic Locations Geography Health Policy Health Services Health Services Accessibility Health Status Hospitalization Inequity Link Lung Malignant Neoplasms Massachusetts Measures Medicare Medicare claim Methodology Methods Modeling Outcome Pancreas Patients Pattern Policies Population Population Characteristics Population Heterogeneity Provider Rectum Rural Rural Population Service delivery model Services Signal Transduction South Dakota Specialist Subgroup Telemedicine Testing Time Transcend Travel Treatment Protocols Urban Population Visit Work access disparities age group beneficiary cancer care cancer health disparity care coordination care delivery care outcomes cohort disparity gap disparity reduction gaps in access geographic difference geographic population geographically distant health care availability health care delivery health care disparity health disparity health equity improved inpatient service melanoma mortality mortality disparity novel population based pre-pandemic rectal rural area rural cancer care sociodemographics symptom management telehealth uptake virtual

Address Adoption American Area Automobile Driving Black race Bladder Breast COVID-19 pandemic Cancer Patient Catchment Area Censuses Clinical Colon Communication Data Dimensions Emergency department visit Equity Fee-for-Service Plans Geographic Locations Geography Health Policy Health Services Health Services Accessibility Health Status Hospitalization Inequity Link Lung Malignant Neoplasms Massachusetts Measures Medicare Medicare claim Methodology Methods Modeling Outcome Pancreas Patients Pattern Policies Population Population Characteristics Population Heterogeneity Provider Rectum Rural Rural Population Service delivery model Services Signal Transduction South Dakota Specialist Subgroup Telemedicine Testing Time Transcend Travel Treatment Protocols Urban Population Visit Work access disparities age group beneficiary cancer care cancer health disparity care coordination care delivery care outcomes cohort disparity gap disparity reduction gaps in access geographic difference geographic population geographically distant health care availability health care delivery health care disparity health disparity health equity improved inpatient service melanoma mortality mortality disparity novel population based pre-pandemic rectal rural area rural cancer care sociodemographics symptom management telehealth uptake virtual

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项目摘要

ABSTRACT Use of telehealth has skyrocketed since the start of the COVID-19 pandemic. Pre-pandemic, only 60,000 of the 63 million fee-for-service Medicare beneficiaries received a telehealth service each month compared to 24.5 million from March to October, 2020, with wide geographic variation in that uptake (e.g. 8.4% in South Dakota to 47.6% in Massachusetts). This telehealth expansion comes at a time when the often-severe access issues for rural individuals have become a focus for health policy and equity. Longer travel times for rural cancer patients have been shown to negatively impact treatment regimens, RCT participation, and symptom management. Multi-specialist teams are often required for comprehensive cancer care, making care coordination in rural areas particularly challenging. These barriers have contributed to the widening gap in cancer mortality between rural and urban patients. Measuring access to cancer care is a fundamental component of both identifying gaps in access, as well as developing care delivery models to mitigate disparities. Because telehealth transcends geographic proximity, it holds great promise for addressing rural cancer care access inequities. Telehealth allows specialists to connect with geographically distant patients and providers who otherwise would have had more restricted options for referral. With the expected persistence of expanded telehealth following the COVID-19 pandemic, the time is now to develop new ways to measure access to cancer care that integrate geospatial measures with telehealth and referral patterns in order to improve equity in health care access and outcomes. Telehealth is now integral to rural cancer care in some regions, yet where gaps are in its use and how inequities in access impact utilization and outcomes is unknown. Only by measuring the new reality of cancer care access that includes telehealth, understanding telehealth impacts on outcomes, and applying this evidence to “what if” scenarios/projections, can we begin to harness and proactively direct the potential that telehealth has to reduce rural cancer disparities. This study will take the critical and timely steps of developing measures of access nationally that incorporate telehealth, identifying determinants of telehealth use in cancer care, testing effects of telehealth on cancer outcomes, and analyzing the projected impact on equity in cancer care access and outcomes if telehealth use in cancer is expanded, while considering differential effects based on the rural-urban continuum. To do this, we will use national Medicare claims for telehealth utilization among cancer patients, Federal Communications Commission (FCC) broadband data, and 2020 Census data for the entire U.S., to extend our prior geospatial cancer care access work (R21CA212687) and population-based outcomes modeling with policy relevance.

抽象的自从19日大流行开始以来，远程医疗的使用飙升。大流行，只有60,000 每月有6300万收费的医疗保险受益人接受远程医疗服务，而24.5 从2020年3月到10月，百万美元的地理差异很大（例如，南达科他州8.4％在马萨诸塞州为47.6％）。这种远程医疗扩展是在经常访问问题的时候对于粗糙的人来说，已经成为卫生政策和公平的重点。粗糙的人的旅行时间更长已显示患者对治疗方案，RCT参与和症状产生负面影响管理。全面的癌症护理通常需要多专业团队在粗糙地区的协调特别具有挑战性。这些障碍有助于扩大差距粗糙患者和城市患者之间的癌症死亡率。衡量获得癌症护理的机会是基本识别访问中差距的组成部分，以及开发护理交付模型以减轻差异。因为远程医疗超越地理位置，它具有解决节奏的巨大希望癌症护理进入不平等。远程医疗允许专家与地理上遥远的患者建立联系，否则将有更多限制的转诊选择的提供者。与预期的持久性扩大了远程医疗，远程医疗是在COVID-19大流行之后，现在是时候开发新的方法来衡量获得癌症护理，将地理空间措施与远程医疗和推荐模式相结合提高医疗保健获得和成果的股权。远程医疗现在是某些农村癌症护理不可或缺的一部分区域，差距在其使用方面以及访问的不平等影响如何影响利用率和结果未知。仅通过衡量包括远程医疗在内的癌症护理获取的新现实，了解远程医疗会影响结果，并将这些证据应用于“如果”场景/预测，我们可以开始利用并主动指导远程医疗减少农村癌症差异的潜力。这项研究会采取在全国范围内制定远程医疗的关键和及时步骤，识别远程医疗在癌症护理中使用的决定者，远程医疗对癌症结果的影响以及如果在癌症中使用远程医疗是扩展，同时考虑基于崎ublan untumum的差异效应。为此，我们将使用癌症患者远程医疗利用的国家医疗保险索赔，联邦通信委员会（FCC）宽带数据和2020年全美国人口普查数据，以扩展我们以前的地理空间癌症护理访问工作（R21CA212687）和基于人群的结果建模具有政策相关性。