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Principal Investigator: ALISA B BUSCH
Organization: HARVARD MEDICAL SCHOOL
Fiscal Year: 2024
Award: $749,529
Funding agency: National Institute on Alcohol Abuse and Alcoholism
PROJECT SUMMARY
While alcohol use disorder (AUD) is a leading cause of morbidity and mortality, and efficacious medication and
behavioral treatments exist, only a small minority with AUD in the US receive any AUD treatment.
Additionally, there are substantial disparities in receiving AUD care across several groups (e.g., racial/ethnic
minorities, women, those who live in rural locations). The COVID-19 pandemic has led to a worsening of the
situation with both increases in unhealthy alcohol use and disruptions in care. However, one potentially
positive change is the dramatic rise in use of telehealth. Telehealth for treatment of AUD could increase access
to care and thereby improve treatment outcomes, but much remains unknown about how telehealth is being
incorporated into AUD care, characteristics of the patients who are receiving different patterns of AUD care
and their AUD providers, and the subsequent outcomes. It is also unclear whether telehealth in AUD care is
reducing or widening disparities in utilization.
To address this knowledge gap we will use a mixed methods study that combines analysis of Medicare,
Medicaid, and commercial insurance claims from 2016-2024, with qualitative interviews, to achieve the
following study aims: 1) identify initial longitudinal patterns of telehealth versus in-person AUD care and
assess patient, provider, and community characteristics associated with different patterns; 2) characterize the
longer-term quality outcomes associated with these initial tele-AUD patterns; 3) assess disparities in AUD
utilization over time and the association between tele-AUD use and these disparities; and, 4) explore the
perspective of providers and individuals with problematic drinking on the quality of different care patterns that
incorporate telehealth and other digital tools.
This study will provide important new information that can inform clinical practice regarding the role of
telehealth in AUD care going forward. It can help answer questions about how best to use tele-AUD to improve
access to and quality of AUD care, reduce disparities, and support recovery. The results will also inform the
ongoing debates on telehealth regulation and reimbursement policy in Congress, state legislatures, Medicaid
programs, and private insurers.
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disease rate><Out-patients><Outcome><Outpatient Care><Outpatients><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Pattern><Patterns of Care><Perception><Persons><Pharmaceutical Preparations><Pharmacological Treatment><Phone><Policies><Population><Privatization><Provider><Psychotherapy><QOC><Quality of Care><Race><Races><Recovery><Recovery Support><Regulation><Risk><Role><Rural><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Severities><Substance Use Disorder><Suicide><Technology><Telephone><Time><Title 18><Treatment outcome><Underserved Population><Visit><Vulnerable Populations><Woman><access to health services><access to services><access to treatment><accessibility to health services><addiction><addictive disorder><adulthood><alcohol abuse therapy><alcohol abuse treatment><alcohol ingestion><alcohol intake><alcohol misuse><alcohol product use><alcohol treatment><alcohol use><alcohol use disorder><alcoholic beverage consumption><alcoholic drink intake><availability of services><behavior intervention><behavioral intervention><cardiovascular disorder><care access><care providers><cirrhotic><clinical care><clinical practice><co-morbid><co-morbidity><comorbidity><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><depression><digital><digital therapeutics><digital therapy><digital tool><digital treatment><disability><disadvantaged group><disadvantaged individual><disadvantaged people><disadvantaged population><disadvantaged subgroup><disparities across groups><disparity across subgroups><disparity among groups><disparity among subgroups><disparity between groups><disparity between subgroups><disparity in care><disparity in healthcare><disparity reduction><drinking><drug/agent><ethanol consumption><ethanol drinking><ethanol ingestion><ethanol intake><ethanol misuse><ethanol product use><ethanol use><ethanol use disorder><ethnic minority><experience><fatal attempt><fatal suicide><group disparity><group inequality><group inequity><health care disparity><health care inequality><health care inequity><health insurance for disabled><health service access><health services availability><healthcare disparity><healthcare inequality><healthcare inequity><improved><inequalities among populations><inequalities between populations><inequalities in populations><inequality across populations><inequality among groups><inequality between groups><inequality in groups><inequities among populations><inequities between populations><inequities in populations><inequity across groups><inequity across populations><inequity between groups><inequity in groups><injuries><insurance claims><intent to die><machine learning based method><machine learning method><machine learning methodologies><malignancy><men><mental health care><mental healthcare><mitigate disparity><mortality><neoplasm/cancer><outpatient programs><outpatient services><outpatient treatment><pandemic><pandemic disease><patient oriented outcomes><population inequality><population inequity><programs><racial><racial background><racial minority><racial origin><reduce disparity><reduction in disparity><rural area><rural dwelling><rural households><rural location><rural region><rural residence><rurality><service availability><service utilization><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><sex><social role><subgroup disparity><substance use and disorder><suicides><telehealth><tool><trait><treatment access><under served group><under served individual><under served people><under served population><underserved group><underserved individual><underserved people><unequal group><unequal population><unhealthy alcohol use><urban area><urban disparity><urban location><urban region><urban residence><vulnerable group><vulnerable individual><vulnerable people>