Chronic diseases have a significant impact on the population, disproportionately affecting rural and minority populations. For patients with chronic diseases, access to specialist care improves outcomes. However, there are many barriers to access to specialists, especially for rural and minority populations. Telemedicine is a potential solution to the problem of access and the uptake of telemedicine for clinical care has been increasing worldwide. Alaska has been a leader in telemedicine innovation. Recently, the use of telemedicine video teleconference (VTC) has expanded dramatically in Alaska for chronic disease specialty care. Few studies have evaluated the outcomes or costs associated with the use of telemedicine VTC in the care of chronic diseases. The objective of this proposal is to evaluate the impact of telemedicine specialty care on chronic disease outcomes and costs. In order to achieve this objective, we propose the following specific aims: 1) determine the predictors of receiving care by telemedicine VTC for chronic disease, including patient, provider, community, and disease characteristics; 2) investigate the relationship between telemedicine VTC care and clinical outcomes of chronic diseases; and 3) perform a cost comparison of telemedicine VTC and in- person visits for chronic disease specialty care.
The first aim will be achieved using a mixed methods approach. Quantitative data from the first aim will be used for propensity score matching of cases and controls in Aims 2 and 3. Alternative analyses will include instrumental variable analysis for Aims 2 and 3 and a difference in difference approach for Aim 3. Data for all aims will be obtained from a variety of sources, including administrative data, quantitative patient-reported data, qualitative patient-reported data, medical record abstraction, quantitative data collected from providers, and cost data from health care system and payer sources. Data will be integrated to fully inform all study aims. This study will contribute substantially to the literature on outcomes and costs associated with the use of telemedicine in chronic disease care. It is relevant to the mission of AHRQ to produce evidence to make health care safer, higher quality, more accessible, equitable and affordable, and specifically relevant to the priority area of focus on improving health care affordability, efficiency and cost transparency.
The proposed study will contribute substantially to our knowledge of the impact of telemedicine care for chronic disease on disease outcomes and associated costs. It will fill a significant gap in the literature, as few studies of telemedicine have focused on chronic disease outcomes or costs. The findings of this study will have broad relevance to health care organizations, payers, physicians, and patients with chronic disease.
