远程医疗和医疗保险 2 型糖尿病护理结果：来自路易斯安那州的证据。

Telehealth and Medicare Type 2 Diabetes Care Outcomes: Evidence From Louisiana.

机构信息

Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.

ConcertAI, Cambridge, MA.

出版信息

Med Care. 2023 Apr 1;61(Suppl 1):S77-S82. doi: 10.1097/MLR.0000000000001724. Epub 2023 Mar 9.

DOI:10.1097/MLR.0000000000001724

PMID:36893422

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9994566/

Abstract

BACKGROUND

At the onset of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services broadened access to telehealth. This provided an opportunity to test whether diabetes, a risk factor for COVID-19 severity, can be managed with telehealth services.

OBJECTIVE

The objective of this study was to examine the impacts of telehealth on diabetes control.

RESEARCH DESIGN

A doubly robust estimator combined a propensity score-weighting strategy with regression controls for baseline characteristics using electronic medical records data to compare outcomes in patients with and without telehealth care. Matching on preperiod trajectories in outpatient visits and weighting by odds were used to ensure comparability between comparators.

SUBJECTS

Medicare patients with type 2 diabetes in Louisiana between March 2018 and February 2021 (9530 patients with a COVID-19 era telehealth visit and 20,666 patients without one).

MEASURES

Primary outcomes were glycemic levels and control [ie, hemoglobin A1c (HbA1c) under 7%]. Secondary outcomes included alternative HbA1c measures, emergency department visits, and inpatient admissions.

RESULTS

Telehealth was associated with lower pandemic era mean A1c values [estimate=-0.080%, 95% confidence interval (CI): -0.111% to -0.048%], which translated to an increased likelihood of having HbA1c in control (estimate=0.013; 95% CI: 0.002-0.024; P<0.023). Hispanic telehealth users had relatively higher COVID-19 era HbA1c levels (estimate=0.125; 95% CI: 0.044-0.205; P<0.003). Telehealth was not associated with differences in the likelihood of having an emergency department visits (estimate=-0.003; 95% CI: -0.011 to 0.004; P<0.351) but was associated with more the likelihood of having an inpatient admission (estimate=0.024; 95% CI: 0.018-0.031; P<0.001).

CONCLUSION

Telehealth use among Medicare patients with type 2 diabetes in Louisiana stemming from the COVID-19 pandemic was associated with relatively improved glycemic control.

摘要

背景

在 COVID-19 大流行开始时，医疗保险和医疗补助服务中心扩大了远程医疗的使用。这为测试糖尿病（COVID-19 严重程度的一个风险因素）是否可以通过远程医疗服务进行管理提供了机会。

目的

本研究旨在检验远程医疗对糖尿病控制的影响。

研究设计

使用电子病历数据，采用倾向评分加权策略和回归控制基线特征的双重稳健估计，比较有和没有远程医疗护理的患者的结局。使用门诊就诊前期间轨迹匹配和优势比加权来确保对照之间的可比性。

受试者

2018 年 3 月至 2021 年 2 月期间路易斯安那州的 2 型糖尿病 Medicare 患者（9530 名 COVID-19 时代有远程医疗就诊的患者和 20666 名没有远程医疗就诊的患者）。

测量指标

主要结局指标为血糖水平和控制情况[即血红蛋白 A1c（HbA1c）低于 7%]。次要结局指标包括替代 HbA1c 测量值、急诊就诊和住院入院。

结果

远程医疗与大流行期间较低的平均 A1c 值相关[估计值=-0.080%，95%置信区间（CI）：-0.111%至-0.048%]，这意味着 HbA1c 控制的可能性增加（估计值=0.013；95%CI：0.002-0.024；P<0.023）。西班牙裔远程医疗使用者的 COVID-19 时代 HbA1c 水平相对较高（估计值=0.125；95%CI：0.044-0.205；P<0.003）。远程医疗与急诊就诊可能性的差异无关（估计值=-0.003；95%CI：-0.011 至 0.004；P<0.351），但与住院入院可能性的增加相关（估计值=0.024；95%CI：0.018-0.031；P<0.001）。