Meta Platforms, Inc, Menlo Park, California.
American Institutes for Research, Arlington, Virginia.
JAMA Netw Open. 2024 May 1;7(5):e2411006. doi: 10.1001/jamanetworkopen.2024.11006.
Understanding the association of telehealth use with health care outcomes is fundamental to determining whether telehealth waivers implemented during the COVID-19 public health emergency should be made permanent. The current literature has yielded inconclusive findings owing to its focus on select states, practices, or health care systems.
To estimate the association of telehealth use with outcomes for all Medicare fee-for-service (FFS) beneficiaries by comparing hospital service areas (HSAs) with different levels of telehealth use.
DESIGN, SETTING, AND PARTICIPANTS: This US population-based, retrospective cohort study was conducted from July 2022 to April 2023. Participants included Medicare claims of beneficiaries attributed to HSAs with FFS enrollment in Parts A and B.
Low, medium, or high tercile of telehealth use created by ranking HSAs according to the number of telehealth visits per 1000 beneficiaries.
The primary outcomes were quality (ambulatory care-sensitive [ACS] hospitalizations and emergency department [ED] visits per 1000 FFS beneficiaries), access to care (clinician encounters per FFS beneficiary), and cost (total cost of care for Part A and/or B services per FFS Medicare beneficiary) determined with a difference-in-difference analysis.
In this cohort study of claims from approximately 30 million Medicare beneficiaries (mean [SD] age in 2019, 71.04 [1.67] years; mean [SD] percentage female in 2019, 53.83% [2.14%]) within 3436 HSAs, between the second half of 2019 and the second half of 2021, mean ACS hospitalizations and ED visits declined sharply, mean clinician encounters per beneficiary declined slightly, and mean total cost of care per beneficiary per semester increased slightly. Compared with the low group, the high group had more ACS hospitalizations (1.63 additional hospitalizations per 1000 beneficiaries; 95% CI, 1.03-2.22 hospitalizations), more clinician encounters (0.30 additional encounters per beneficiary per semester; 95% CI, 0.23-0.38 encounters), and higher total cost of care ($164.99 higher cost per beneficiary per semester; 95% CI, $101.03-$228.96). There was no statistically significant difference in ACS ED visits between the low and high groups.
In this cohort study of Medicare beneficiaries across all 3436 HSAs, high levels of telehealth use were associated with more clinician encounters, more ACS hospitalizations, and higher total health care costs. COVID-19 cases were still high during the period of study, which suggests that these findings partially reflect a higher capacity for providing health services in HSAs with higher telehealth intensity than other HSAs.
了解远程医疗使用与医疗保健结果之间的关联对于确定在 COVID-19 公共卫生紧急情况下实施的远程医疗豁免是否应该永久化至关重要。由于其专注于特定州、实践或医疗保健系统，当前的文献得出的结论尚无定论。
通过比较具有不同远程医疗使用水平的医院服务区 (HSA)，估计所有 Medicare 按服务收费 (FFS) 受益人的远程医疗使用与结果之间的关联。
设计、设置和参与者：这是一项基于美国人群的回顾性队列研究，于 2022 年 7 月至 2023 年 4 月进行。参与者包括归因于 FFS 参保的 HSA 的 Medicare 索赔，这些 HSA 参与了 Medicare 的 A 部分和 B 部分。
通过根据每 1000 名受益人的远程医疗访问次数对 HSA 进行排名，创建低、中、高三分位数的远程医疗使用。
主要结果是通过差异分析确定的质量（每 1000 名 FFS 受益人的门诊护理敏感 [ACS] 住院和急诊就诊）、获得护理的机会（每位 FFS 受益人的临床医生就诊次数）和成本（每位 FFS Medicare 受益人的 A 部分和/或 B 部分服务总成本）。
在这项针对约 3000 万 Medicare 受益人的索赔的队列研究中（2019 年平均[标准差]年龄为 71.04 [1.67]岁；2019 年平均[标准差]女性百分比为 53.83%[2.14%]）在 3436 个 HSA 中，在 2019 年下半年至 2021 年下半年期间，ACS 住院和 ED 就诊人数急剧下降，每位受益人的临床医生就诊次数略有下降，每位受益人的每学期总护理成本略有增加。与低组相比，高组 ACS 住院人数更多（每 1000 名受益人的额外住院人数为 1.63；95%CI，1.03-2.22 次住院），临床医生就诊次数更多（每学期每位受益人的额外就诊次数为 0.30；95%CI，0.23-0.38 次就诊），总护理成本更高（每位受益人的每学期成本增加 164.99 美元；95%CI，101.03-228.96 美元）。低组和高组之间的 ACS ED 就诊次数没有统计学上的显著差异。
在这项针对所有 3436 个 HSA 的 Medicare 受益人的队列研究中，高水平的远程医疗使用与更多的临床医生就诊、更多的 ACS 住院和更高的整体医疗保健费用有关。在研究期间，COVID-19 病例仍然居高不下，这表明这些发现部分反映了在远程医疗强度较高的 HSA 中提供医疗服务的能力更高，而不是其他 HSA。
Zotero 插件