2019年冠状病毒病疫情期间医疗保险按服务收费受益人的宽带容量与远程医疗利用之间的关联
Association between broadband capacity and telehealth utilization among Medicare Fee-for-service beneficiaries during the COVID-19 pandemic.
作者信息
Pandit Ambrish A, Mahashabde Ruchira V, Brown Clare C, Acharya Mahip, Shoults Catherine C, Eswaran Hari, Hayes Corey J
机构信息
Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
出版信息
J Telemed Telecare. 2025 Jan;31(1):41-48. doi: 10.1177/1357633X231166026. Epub 2023 Apr 5.
BACKGROUND
Telehealth is a rapidly growing modality for expanding healthcare access, especially in the post-COVID-19 era. However, telehealth requires high-quality broadband, thus making broadband a social determinant of health. The objective of this study was to evaluate the association between broadband access and telehealth utilization across the United States during the COVID-19 pandemic.
METHODS
Using a cross-sectional, ecological study design, we merged county-level data on broadband capacity (Microsoft's Rural Broadband Initiative), telehealth utilization among Medicare Fee-for-Service beneficiaries from January through September 2020 (CareJourney), and county-level socioeconomic characteristics (Area Health Resources Files). Multivariable linear regression was used to estimate the association between broadband capacity, county-level characteristics, and telehealth utilization.
RESULTS
Among the 3107 counties, those with the greatest broadband availability (quintile 5) had 47% higher telehealth utilization compared to counties with the least broadband availability (quintile 1). In the adjusted model, a 1 standard deviation (SD) increase in broadband access was associated with a 1.54 percentage point (pp) increase in telehealth utilization (P < 0.001). Rural county designation (-1.96 pp; P < 0.001) and 1 SD increases in average Medicare beneficiary age (-1.34 pp; P = 0.001), number of nursing home beds per 1000 individuals (-0.38 pp; P = 0.002), and proportion of Native Americans/Pacific Islanders (-0.59 pp; P < 0.001) were associated with decreased telehealth utilization.
CONCLUSION
The association between broadband access and telehealth utilization and the decreased telehealth utilization in rural areas highlight the importance of broadband access for healthcare access and the need to continue investing in broadband infrastructure to promote equitable healthcare access across populations.
背景
远程医疗是一种迅速发展的医疗模式，有助于扩大医疗服务的可及性，尤其是在新冠疫情后的时代。然而，远程医疗需要高质量的宽带，因此宽带成为了健康的一个社会决定因素。本研究的目的是评估新冠疫情期间美国各地宽带接入与远程医疗使用之间的关联。
方法
采用横断面生态研究设计，我们将县级宽带容量数据（微软农村宽带计划）、2020年1月至9月医疗保险按服务收费受益人的远程医疗使用情况（CareJourney）以及县级社会经济特征数据（地区卫生资源文件）进行了合并。使用多变量线性回归来估计宽带容量、县级特征与远程医疗使用之间的关联。
结果
在3107个县中，宽带可用性最高的县（第5五分位数）的远程医疗使用率比宽带可用性最低的县（第1五分位数）高47%。在调整后的模型中，宽带接入增加1个标准差（SD）与远程医疗使用率增加1.54个百分点（pp）相关（P < 0.001）。农村县的指定（-1.96 pp；P < 0.001）以及医疗保险受益人的平均年龄增加1个SD（-1.34 pp；P = 0.001）、每1000人养老院床位数量增加1个SD（-0.38 pp；P = 0.002）和美洲原住民/太平洋岛民的比例增加（-0.59 pp；P < 0.001）与远程医疗使用率下降相关。
结论
宽带接入与远程医疗使用之间的关联以及农村地区远程医疗使用率的下降凸显了宽带接入对于医疗服务可及性的重要性，以及持续投资宽带基础设施以促进全民公平医疗服务可及性的必要性。
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