Telemedicine-Based Collaborative Care to Reduce Rural Health Disparities

基于远程医疗的协作护理减少农村健康差距

基本信息

批准号：
7875672
负责人：
JOHN C. FORTNEY
金额：
$ 2.87万
依托单位：
UNIV OF ARKANSAS FOR MED SCIS
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-01 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7875672
关键词：
Adoption American Antidepressive Agents Area Arkansas Arts Caring Chronic Chronic Care Chronic Disease Clinic Clinical Community Health Community Health Centers Computerized Medical Record Contracts Country Disease Educational workshop Effectiveness Electronic Health Record Emotional Engineering Evidence based practice Evidence based treatment Face Fasting Funding Future Goals Health Policy Health Services Accessibility Healthcare Healthcare Systems Individual Information Systems Intervention Life Location Low income Medically Underserved Area Mental Health Mental Health Services Minority Mission Modeling Mood Disorders NIH Program Announcements National Institute of Mental Health Outcome Patient Access to Records Patients Physician Executives Policies Policy Maker Population Primary Health Care Principal Investigator Process Provider Public Health Publishing Randomized Controlled Clinical Trials Relative (related person)Reporting Research Research Infrastructure Research Personnel Resources Rest Rural Rural Community Rural Health Rural Population Services Site Societies Specialist System Target Populations Technology Telemedicine Telephone Testing Translations United States Dept. of Health and Human Services United States Health Resources and Services Administration Veterans Visit base care delivery care systems chronic care model collaborative care compare effectiveness cost cost effectiveness depression design evidence base experience health disparity health related quality of life high risk improved innovation mental health center multidisciplinary novel organizational structure outreach patient population portability preference primary care setting programs rural area rural disparities satisfaction severe mental illness suicide rate technological innovation treatment adherence treatment as usual web site

项目摘要

Rural individuals with depression face substantial barriers to care, seldom receive evidence-based treatment, and experience poor outcomes. Collaborative care has been documented to improve outcomes in large urban Primary Care (PC) clinics. Implementing collaborative care in small rural practices presents a unique challenge because it is not feasible to employ on-site multidisciplinary care teams dedicated to depression treatment. No published studies have documented the effectiveness of collaborative care in small rural PC clinics. In fact, one recent collaborative care effectiveness study conducted in both rural and urban practices found that outcomes were significantly improved in urban clinics, but not rural clinics. Results from our current VA study demonstrate that telemedicine-based collaborative care is effective in small rural PC clinics. Telemedicine-based collaborative care was provided to rural clinics by an off-site depression care team using telephones, emails, interactive video, and a shared electronic medical record. A critical question for the field is whether it is more effective for small rural clinics to provide collaborative care services on-site (practice-based collaborative care model) or to contract with an off-site care team that specializes in providing collaborative care to multiple clinics from a centralized location using telemedicine technologies (telemedicine-based model). We propose to compare the effectiveness/cost-effectiveness of telemedicine-based collaborative care to practice-based collaborative care in six Community Health Center (CMC) systems in rural Arkansas. In 2003, 890 federally-funded CHCs served over 12 million poor, ethnically diverse patients living in medically underserved areas. CHCs are in the process of re-engineering clinics to provide practice-based collaborative care as a part of the Health Disparities Collaboratives. The proposed research has the potential to have a major public health impact because the results should be generalizable to the hundreds of rural CHCs across the country. CHCs represent one of the largest and fasting growing PC systems in the nation, and thus results should be applicable to a large number of providers and patients across the nation. In addition, CHCs serve predominantly low income minority populations living in medically underserved areas. This population is at high risk for experiencing health disparities and thus, interventions targeting this population have the potential to have a major impact.

抑郁症患者面临着重大护理障碍，很少获得循证治疗并经历不良的结果。已记录了协作护理以改善结果在大型城市初级保健（PC）诊所中。在小型农村实践中实施协作护理提出独特的挑战，因为使用专门用于的现场多学科护理团队是不可行的抑郁症治疗。没有发表的研究记录了协作护理在小型农村PC诊所。实际上，在农村和城市实践发现，在城市诊所，但没有农村诊所的结果显着改善。结果从当前的VA研究中，基于远程医疗的协作护理在小农村地区有效 PC诊所。基于远程医疗的协作护理是通过现场抑郁症向农村诊所提供的护理团队使用电话，电子邮件，互动视频和共享的电子病历。批判该领域的问题是，小型农村诊所提供协作护理是否更有效现场服务（基于实践的协作护理模型）或与现场护理团队签约专门使用远程医疗从集中位置向多个诊所提供协作护理技术（基于远程医疗的模型）。我们建议比较基于远程医疗的协作护理至六个社区卫生中心的基于实践的协作护理（CMC）阿肯色州农村的系统。 2003年，有890个联邦政府资助的CHC为超过1200万的穷人服务，居住在医学贫乏地区的种族多样化的患者。 CHC正在重新设计诊所提供基于实践的协作护理，作为健康差异协作的一部分。拟议的研究有可能对公共卫生产生重大影响，因为结果应该可以推广到全国数百个农村卫生室。 CHC是最大的之一，禁食全国生长的PC系统，因此结果应适用于大量全国提供者和患者。此外，CHC主要服务于低收入的少数民族生活在医学不足的地区。这个人群有健康健康的风险差距以及针对该人群的干预措施有可能产生重大影响。