The Changing Landscape of Post-Acute Care and Health Outcomes for Older Adults

老年人急性后护理和健康结果的变化

• 批准号: 10253539
• 负责人: Michael Lawrence Barnett
• 金额: $ 9.84万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10253539
• 关键词: Acute; Address; Adopted; Adoption; Aging; Ambulatory Care; American; Area; COVID-19; COVID-19 outbreak; COVID-19 pandemic; COVID-19 treatment; Caring; Cessation of life; Characteristics; Clinical; Communities; Controlled Study; Coronavirus; Development; Elderly; Emergency Situation; Evaluation; Future; Geography; Geriatric Psychiatry; Growth; Health; Health Policy; Health care facility; Hospitalization; Hour; Impairment; Individual; Investments; Lifting; Long-Term Care; Measures; Medical; Medicare; Mentored Patient-Oriented Research Career Development Award; Mission; Motivation; Nature; Nursing Homes; Outcome; Parents; Patient-Focused Outcomes; Personal Satisfaction; Persons; Physicians; Play; Policies; Provider; Public Health; Regulation; Research; Research Personnel; Role; Rural; Savings; Services; Skilled Nursing Facilities; Specialist; Surveys; Technology; Telemedicine; Time; Training; Variant; Visit; Work; acute care; base; care delivery; clinical care; commune; coronavirus disease; design; disadvantaged population; financial incentive; flexibility; improved; innovation; insight; medical specialties; pandemic disease; patient variability; payment; prevent; programs; remote health care; response; rural area; telehealth; trend; urban area; virtual healthcare; waiver

PROJECT SUMMARY The COVID-19 pandemic has been devastating for nursing homes in the US. In response to the unprecedented threat posed by the pandemic, Medicare required SNFs to impose a number of measures to reduce the spread of COVID-19, including a ban on outside visitors. One consequence of this lockdown was an overnight transformation of the nature of care delivery in SNFs. Specifically, Medicare waived long-standing requirements around physician evaluation for SNF residents, including new flexibility for all SNFs to provide care remotely via telehealth, previously restricted to rural SNFs under specific conditions. Telemedicine has long been regarded as a promising innovation in care delivery for SNFs, whose residents have significant medical needs and impaired mobility. Unfortunately, adoption has been limited. The barriers to telemedicine use in SNFs are not clinical, but primarily misaligned financial incentives. Telemedicine requires investment in technology, training and culture change, but comes with little additional reimbursement. The COVID-19 pandemic dramatically changed the clinical motivation for SNFs to use telemedicine and the financial incentives for physicians to provide those services. Little is known about how SNFs have used telemedicine after COVID-19 emerged. There are many evidence gaps, such as understanding the extent of telemedicine adoption in SNFs, what services are delivered through virtual care, which sorts of physicians deliver them, and what factors contribute to variation in telemedicine use. Answers to these questions are necessary to advance policy for future reimbursement and use of this technology in SNFs moving forward. The objective of this K23 supplement is to characterize the adoption and use of telemedicine in SNFs for the care of COVID-19 and non-COVID clinical care. My overarching hypothesis is that the COVID-19 pandemic has vastly accelerated telemedicine adoption in SNFs for both COVID-19 treatment and other clinical care, especially at facilities with COVID-19 outbreaks. I propose two Aims: 1) Characterize the adoption and use of telemedicine for COVID-19 treatment in SNFs with COVID-19 cases and variation by patient, facility and geographic characteristics. 2) Characterize the delivery of all non-COVID-19 clinical care in SNFs with differing levels of telemedicine use before and during the COVID-19 pandemic. These Aims will provide detailed insight into how SNFs have adapted care delivery under unprecedented circumstances. Evidence on telemedicine adoption at SNFs can inform the future of Medicare regulation, state and federal investment in SNF telemedicine and the design of payment policy during future waves of COVID-19.

项目概要 COVID-19 大流行对美国的疗养院造成了毁灭性的打击。响应 面对疫情带来的前所未有的威胁，医疗保险要求 SNF 采取一系列措施， 减少 COVID-19 的传播，包括禁止外部访客。这次封锁的后果之一是 SNF 的护理服务性质一夜间发生转变。具体来说，医疗保险放弃了长期存在的 围绕 SNF 居民医生评估的要求，包括所有 SNF 提供的新灵活性 通过远程医疗进行远程护理，以前仅限于特定条件下的农村 SNF。 远程医疗长期以来一直被认为是 SNF 护理服务领域一项有前途的创新，其 居民有巨大的医疗需求和行动不便。不幸的是，采用率有限。这 SNF 中使用远程医疗的障碍不是临床原因，而主要是财务激励措施的失调。远程医疗 需要对技术、培训和文化变革进行投资，但几乎没有额外的回报。 COVID-19 大流行极大地改变了 SNF 使用远程医疗的临床动机以及 对医生提供这些服务的经济激励。 COVID-19 出现后，人们对 SNF 如何使用远程医疗知之甚少。有许多 证据差距，例如了解 SNF 中远程医疗采用的程度、哪些服务 通过虚拟护理提供的服务、哪些类型的医生提供服务以及哪些因素导致了治疗结果的变化 远程医疗的使用。这些问题的答案对于推进未来报销政策和 未来将在 SNF 中使用该技术。 本 K23 补充材料的目的是描述 SNF 中远程医疗的采用和使用 用于 COVID-19 的护理和非 COVID 临床护理。我的首要假设是 COVID-19 大流行极大地加速了 SNF 中远程医疗在 COVID-19 治疗和其他方面的采用 临床护理，尤其是在爆发 COVID-19 的机构中。我提出两个目标： 1) 描述在有 COVID-19 病例的 SNF 中采用和使用远程医疗进行 COVID-19 治疗的特点 以及患者、设施和地理特征的变化。 2) 描述具有不同远程医疗使用水平的 SNF 中所有非 COVID-19 临床护理的提供情况 在 COVID-19 大流行之前和期间。 这些目标将详细介绍 SNF 如何在以下情况下调整护理服务： 前所未有的情况。 SNF 采用远程医疗的证据可以为医疗保险的未来提供信息 监管、州和联邦对 SNF 远程医疗的投资以及未来支付政策的设计 COVID-19 浪潮。