Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness

被引:12
作者
Wilcock, Andrew D. [1 ]
Huskamp, Haiden A. [1 ]
Busch, Alisa B. [1 ,2 ]
Normand, Sharon-Lise T. [1 ,3 ]
Uscher-Pines, Lori [4 ]
Raja, Pushpa V. [5 ]
Zubizarreta, Jose R. [1 ,3 ,6 ]
Barnett, Michael L. [7 ,8 ]
Mehrotra, Ateev [1 ,9 ]
机构
[1] Harvard Med Sch, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA
[2] McLean Hosp, Belmont, MA USA
[3] Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA USA
[4] RAND Hlth, Arlington, VA USA
[5] Vet Affairs Greater Los Angeles Healthcare Syst, Dept Mental Hlth, Los Angeles, CA USA
[6] Harvard Univ, Dept Stat, Cambridge, MA USA
[7] Harvard TH Chan Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA
[8] Brigham & Womens Hosp, Dept Med, Boston, MA USA
[9] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA USA
来源
JAMA HEALTH FORUM | 2023年 / 4卷 / 10期
关键词
HEALTH SYSTEM; VETERANS; SCHIZOPHRENIA; DEPRESSION; MORTALITY; TELEPSYCHIATRY; ACCEPTANCE; RETENTION; LOST;
D O I
10.1001/jamahealthforum.2023.3648
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Importance During the COVID-19 pandemic, a large fraction of mental health care was provided via telemedicine. The implications of this shift in care for use of mental health service and quality of care have not been characterized.Objective To compare changes in care patterns and quality during the first year of the pandemic among Medicare beneficiaries with serious mental illness (schizophrenia or bipolar I disorder) cared for at practices with higher vs lower telemedicine use.Design, Setting, and Participants In this cohort study, Medicare fee-for-service beneficiaries with schizophrenia or bipolar I disorder were attributed to specialty mental health practices that delivered the majority of their mental health care in 2019. Practices were categorized into 3 groups based on the proportion of telemental health visits provided during the first year of the pandemic (March 2020-February 2021): lowest use (0%-49%), middle use (50%-89%), or highest use (90%-100%). Across the 3 groups of practices, differential changes in patient outcomes were calculated from the year before the pandemic started to the year after. These changes were also compared with differential changes from a 2-year prepandemic period. Analyses were conducted in November 2022.Exposure Practice-level use of telemedicine during the first year of the COVID-19 pandemic.Main Outcomes and Measures The primary outcome was the total number of mental health visits (telemedicine plus in-person) per person. Secondary outcomes included the number of acute hospital and emergency department encounters, all-cause mortality, and quality outcomes, including adherence to antipsychotic and mood-stabilizing medications (as measured by the number of months of medication fills) and 7- and 30-day outpatient follow-up rates after discharge for a mental health hospitalization.Results The pandemic cohort included 120 050 Medicare beneficiaries (mean [SD] age, 56.5 [14.5] years; 66 638 females [55.5%]) with serious mental illness. Compared with prepandemic changes and relative to patients receiving care at practices with the lowest telemedicine use: patients receiving care at practices in the middle and highest telemedicine use groups had 1.11 (95% CI, 0.45-1.76) and 1.94 (95% CI, 1.28-2.59) more mental health visits per patient per year (or 7.5% [95% CI, 3.0%-11.9%] and 13.0% [95% CI, 8.6%-17.4%] more mental health visits per year, respectively). Among patients of practices with middle and highest telemedicine use, changes in adherence to antipsychotic and mood-stabilizing medications were -0.4% (95% CI, -1.3% to 0.5%) and -0.1% (95% CI, -1.0% to 0.8%), and hospital and emergency department use for any reason changed by 2.4% (95% CI, -1.5% to 6.2%) and 2.8% (95% CI, -1.2% to 6.8%), respectively. There were no significant differential changes in postdischarge follow-up or mortality rates according to the level of telemedicine use.Conclusions and Relevance In this cohort study of Medicare beneficiaries with serious mental illness, patients receiving care from practices that had a higher level of telemedicine use during the COVID-19 pandemic had more mental health visits per year compared with prepandemic levels, with no differential changes in other observed quality metrics over the same period.
引用
收藏
页数:15
相关论文
共 40 条
[21]   Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: I. Clinical Outcomes [J].
Jester, Dylan J. ;
Thomas, Michael L. ;
Sturm, Emily T. ;
Harvey, Philip D. ;
Keshavan, Matcheri ;
Davis, Beshaun J. ;
Saxena, Shekhar ;
Tampi, Rajesh ;
Leutwyler, Heather ;
Compton, Michael T. ;
Palmer, Barton W. ;
Jeste, Dilip, V .
SCHIZOPHRENIA BULLETIN, 2023, 49 (04) :837-850
[22]  
Kasckow John, 2014, Clin Schizophr Relat Psychoses, V8, P21, DOI 10.3371/CSRP.KAFE.021513
[23]   Rural Residents With Mental Health Needs Have Fewer Care Visits Than Urban Counterparts [J].
Kirby, James B. ;
Zuvekas, Samuel H. ;
Borsky, Amanda E. ;
Ngo-Metzger, Quyen .
HEALTH AFFAIRS, 2019, 38 (12) :2057-2060
[24]   The COVID-19 Global Pandemic: Implications for People With Schizophrenia and Related Disorders [J].
Kozloff, Nicole ;
Mulsant, Benoit H. ;
Stergiopoulos, Vicky ;
Voineskos, Aristotle N. .
SCHIZOPHRENIA BULLETIN, 2020, 46 (04) :752-757
[25]   Association Between Primary Care Practice Telehealth Use and Acute Care Visits for Ambulatory Care-Sensitive Conditions During COVID-19 [J].
Li, Kathleen Y. ;
Ng, Sophia ;
Zhu, Ziwei ;
McCullough, Jeffrey S. ;
Kocher, Keith E. ;
Ellimoottil, Chad .
JAMA NETWORK OPEN, 2022, 5 (03)
[26]   Outpatient Telehealth Implementation in the United States during the COVID-19 Global Pandemic: A Systematic Review [J].
Lieneck, Cristian ;
Weaver, Eric ;
Maryon, Thomas .
MEDICINA-LITHUANIA, 2021, 57 (05)
[27]   Veterans Affairs Health System and mental health treatment retention among patients with serious mental illness: Evaluating accessibility and availability barriers [J].
McCarthy, John F. ;
Blow, Federic C. ;
Valenstein, Marcia ;
Fischer, Ellen P. ;
Owen, Richard R. ;
Barry, Kristen L. ;
Hudson, Teresa J. ;
Ignacio, Rosalinda V. .
HEALTH SERVICES RESEARCH, 2007, 42 (03) :1042-1060
[28]   Paying for Telemedicine After the Pandemic [J].
Mehrotra, Ateev ;
Bhatia, R. Sacha ;
Snoswell, Centaine L. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2021, 325 (05) :431-432
[29]   Access to Care for Veterans With Serious Mental Illness During the COVID-19 Pandemic [J].
Raja, Pushpa, V ;
Gabrielian, Sonya ;
Doran, Neal .
PSYCHIATRIC SERVICES, 2021, 72 (11) :1324-1327
[30]   A methodology for identifying behavioral health advanced practice registered nurses in administrative claims [J].
Richard, Jessica, V ;
Huskamp, Haiden A. ;
Barnett, Michael L. ;
Busch, Alisa B. ;
Mehrotra, Ateev .
HEALTH SERVICES RESEARCH, 2022, 57 (04) :973-978