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Telemedicine Visits in US Skilled Nursing Facilities

IMPORTANCE: Telemedicine in skilled nursing facilities (SNFs) has the potential to improve access and timeliness of care. During the COVID-19 pandemic in 2020 to 2022, telemedicine coverage expanded, but little is known about patterns of use in SNFs. OBJECTIVE: To describe patterns of telemedicine u...

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Autores principales: Ulyte, Agne, Mehrotra, Ateev, Wilcock, Andrew D., SteelFisher, Gillian K., Grabowski, David C., Barnett, Michael L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10439478/
https://www.ncbi.nlm.nih.gov/pubmed/37594760
http://dx.doi.org/10.1001/jamanetworkopen.2023.29895
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author Ulyte, Agne
Mehrotra, Ateev
Wilcock, Andrew D.
SteelFisher, Gillian K.
Grabowski, David C.
Barnett, Michael L.
author_facet Ulyte, Agne
Mehrotra, Ateev
Wilcock, Andrew D.
SteelFisher, Gillian K.
Grabowski, David C.
Barnett, Michael L.
author_sort Ulyte, Agne
collection PubMed
description IMPORTANCE: Telemedicine in skilled nursing facilities (SNFs) has the potential to improve access and timeliness of care. During the COVID-19 pandemic in 2020 to 2022, telemedicine coverage expanded, but little is known about patterns of use in SNFs. OBJECTIVE: To describe patterns of telemedicine use in SNFs. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used 2018 to 2022 Medicare fee-for-service claims and Minimum Data Set 3.0 records to identify short- and long-term care SNF residents. Clinician visits were grouped into routine SNF visits (ie, regular primary care within SNF) and other outpatient visits (ie, with non-SNF affiliated primary and specialty care clinicians). Using a difference-in-differences approach, assessments included whether off-hours visits (measured as weekend visits), new specialist visits, psychiatrist visits, or visits for residents with limited mobility changed differentially between 2018 to 2019 and 2020 to 2021 for SNFs with high compared with low telemedicine use in 2020. EXPOSURE: Telemedicine adoption at SNF after 2020. MAIN OUTCOMES AND MEASURES: Number and proportion of telemedicine SNF and outpatient visits. RESULTS: Across 15 434 SNFs and 4 463 591 residents from the period January 2019 through June 2022 (mean [SD] age, 79.7 [11.6] years; 61% female in 2020), telemedicine visits increased from 0.15% in January 2019 to February 2020 to 15% SNF visits and 25% outpatient visits in May 2020. By 2022, telemedicine dropped to 2% of SNF visits and 8% of outpatient visits. The proportion of SNFs with any telemedicine visits annually dropped from 91% in 2020 to 61% in 2022. The facilities with high telemedicine use were more likely to be rural (adjusted odds ratio vs urban, 2.06; 95% CI, 1.77 to 2.40). Psychiatry visits differentially increased in high vs low telemedicine-use SNFs (20.2% relative increase; 95% CI, 1.2% to 39.2%). In contrast, there was little change in outpatient visits for residents with limited mobility (7.2%; 95% CI, −0.1% to 14.6%) or new specialist visits (−0.7%; 95% CI, −2.5% to 1.2%). CONCLUSIONS AND RELEVANCE: In this cohort study of SNF residents, telemedicine was rapidly adopted in early 2020 but subsequently stabilized at a low use rate that was nonetheless higher than before 2020. Higher telemedicine use in SNFs was associated with improved access to psychiatry visits in SNFs. A policy to encourage continued telemedicine use may facilitate further access to important services as the technology matures.
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spelling pubmed-104394782023-08-20 Telemedicine Visits in US Skilled Nursing Facilities Ulyte, Agne Mehrotra, Ateev Wilcock, Andrew D. SteelFisher, Gillian K. Grabowski, David C. Barnett, Michael L. JAMA Netw Open Original Investigation IMPORTANCE: Telemedicine in skilled nursing facilities (SNFs) has the potential to improve access and timeliness of care. During the COVID-19 pandemic in 2020 to 2022, telemedicine coverage expanded, but little is known about patterns of use in SNFs. OBJECTIVE: To describe patterns of telemedicine use in SNFs. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used 2018 to 2022 Medicare fee-for-service claims and Minimum Data Set 3.0 records to identify short- and long-term care SNF residents. Clinician visits were grouped into routine SNF visits (ie, regular primary care within SNF) and other outpatient visits (ie, with non-SNF affiliated primary and specialty care clinicians). Using a difference-in-differences approach, assessments included whether off-hours visits (measured as weekend visits), new specialist visits, psychiatrist visits, or visits for residents with limited mobility changed differentially between 2018 to 2019 and 2020 to 2021 for SNFs with high compared with low telemedicine use in 2020. EXPOSURE: Telemedicine adoption at SNF after 2020. MAIN OUTCOMES AND MEASURES: Number and proportion of telemedicine SNF and outpatient visits. RESULTS: Across 15 434 SNFs and 4 463 591 residents from the period January 2019 through June 2022 (mean [SD] age, 79.7 [11.6] years; 61% female in 2020), telemedicine visits increased from 0.15% in January 2019 to February 2020 to 15% SNF visits and 25% outpatient visits in May 2020. By 2022, telemedicine dropped to 2% of SNF visits and 8% of outpatient visits. The proportion of SNFs with any telemedicine visits annually dropped from 91% in 2020 to 61% in 2022. The facilities with high telemedicine use were more likely to be rural (adjusted odds ratio vs urban, 2.06; 95% CI, 1.77 to 2.40). Psychiatry visits differentially increased in high vs low telemedicine-use SNFs (20.2% relative increase; 95% CI, 1.2% to 39.2%). In contrast, there was little change in outpatient visits for residents with limited mobility (7.2%; 95% CI, −0.1% to 14.6%) or new specialist visits (−0.7%; 95% CI, −2.5% to 1.2%). CONCLUSIONS AND RELEVANCE: In this cohort study of SNF residents, telemedicine was rapidly adopted in early 2020 but subsequently stabilized at a low use rate that was nonetheless higher than before 2020. Higher telemedicine use in SNFs was associated with improved access to psychiatry visits in SNFs. A policy to encourage continued telemedicine use may facilitate further access to important services as the technology matures. American Medical Association 2023-08-18 /pmc/articles/PMC10439478/ /pubmed/37594760 http://dx.doi.org/10.1001/jamanetworkopen.2023.29895 Text en Copyright 2023 Ulyte A et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Ulyte, Agne
Mehrotra, Ateev
Wilcock, Andrew D.
SteelFisher, Gillian K.
Grabowski, David C.
Barnett, Michael L.
Telemedicine Visits in US Skilled Nursing Facilities
title Telemedicine Visits in US Skilled Nursing Facilities
title_full Telemedicine Visits in US Skilled Nursing Facilities
title_fullStr Telemedicine Visits in US Skilled Nursing Facilities
title_full_unstemmed Telemedicine Visits in US Skilled Nursing Facilities
title_short Telemedicine Visits in US Skilled Nursing Facilities
title_sort telemedicine visits in us skilled nursing facilities
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10439478/
https://www.ncbi.nlm.nih.gov/pubmed/37594760
http://dx.doi.org/10.1001/jamanetworkopen.2023.29895
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