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

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 COVID-19 大流行爆发前以来，远程医疗的使用量猛增，但仅占 60,000 人。每月有 6,300 万按服务收费的 Medicare 受益人接受远程医疗服务，而这一比例为 24.5 2020 年 3 月至 10 月期间，这一数字的地域差异很大（例如南达科他州为 8.4%）在马萨诸塞州，远程医疗的比例达到了 47.6%）。农村癌症患者的旅行时间更长已成为卫生政策和公平的重点。患者已被证明会对治疗方案、RCT 参与和症状产生负面影响综合癌症护理通常需要多专家团队进行护理。这些障碍导致农村地区的差距不断扩大。衡量农村和城市患者的癌症死亡率是一个基本原则。是确定获取途径差距以及开发护理服务模式以缓解影响的组成部分由于远程医疗超越了地理邻近性，因此它在解决农村问题方面前景广阔。癌症护理获取不平等问题使专家能够与地理遥远的患者建立联系。否则，由于预期的持续性，他们的转诊选择会受到更多限制。在 COVID-19 大流行之后，远程医疗得到了扩展，现在是时候开发新的衡量方法了获得将地理空间措施与远程医疗和转诊模式相结合的癌症护理，以便改善医疗保健获取和结果的公平性现在已成为一些农村癌症护理的组成部分。地区，但其使用方面存在哪些差距，以及获取方面的不平等如何影响利用和结果未知。只有通过衡量癌症护理获取的新现实，包括远程医疗、了解。远程医疗对结果的影响，并将这些证据应用于“假设”场景/预测，我们可以开始这项研究将利用并积极引导远程医疗的潜力来减少农村癌症差异。采取关键而及时的步骤，在全国范围内制定纳入远程医疗的准入措施，确定癌症护理中远程医疗使用的决定因素，测试远程医疗对癌症结果的影响，以及分析如果远程医疗在癌症中的使用对癌症护理获取和结果公平性的预计影响扩大，同时考虑基于城乡连续体的差异效应。为此，我们将使用。国家医疗保险要求癌症患者使用远程医疗，联邦通信委员会 (FCC) 宽带数据以及整个美国的 2020 年人口普查数据，以扩展我们之前的地理空间癌症护理获取工作（R21CA212687）和具有政策相关性的基于人群的结果建模。