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Principal Investigator: Jiani Yu
Organization: WEILL MEDICAL COLL OF CORNELL UNIV
Fiscal Year: 2024
Award: $126,590
Funding agency: National Institute on Aging
PROJECT SUMMARY/ABSTRACT
CMS expanded telehealth coverage for Medicare beneficiaries in March 2020, removing multiple barriers to the
provision of telehealth in skilled nursing facilities (SNFs). While telehealth has the potential to reduce potentially
avoidable hospital readmissions and emergency department visits for patients in SNFs, there is very limited
evidence on the impact of telehealth provision for Medicare beneficiaries in SNFs. Furthermore, although roughly
25% of Medicare beneficiaries in SNFs have a diagnosis of Alzheimer's disease and related dementias (ADRD),
there is no population-level evidence on the impact of telehealth provision in SNFs for beneficiaries with ADRD.
Although telehealth may improve access to necessary specialty care for patients with ADRD, there are numerous
ADRD-specific barriers to telehealth use. The overall objectives for this proposal are to examine telehealth
growth and the effect of telehealth provision on utilization, cost, and quality of care for Medicare beneficiaries
with ADRD in SNFs and for beneficiaries generally in SNFs, and to examine facilitators of telehealth provision in
SNFs. Through the proposed training plan, which includes a combination of formal coursework, workshops, and
clinical rotations, as well as a multi-disciplinary mentorship team of NIH-funded investigators, the applicant will
gain clinical knowledge on the treatment of PAC patients, with a focus on patients with ADRD, expertise in
qualitative and mixed methods, and an understanding of telehealth implementation. Dr. Yu will use the methods
and content knowledge gained through these training activities to achieve the following specific aims: (1)
Examine the patterns of telehealth use for all SNF patients and for SNF patients with ADRD before and after the
expansion of Medicare coverage, and assess the relative change in SNF telehealth and in-person visits; (2)
Estimate the relationship between SNF telehealth provision and utilization, cost, and quality of care for all SNF
patients and for SNF patients with ADRD; and (3) Identify SNF characteristics associated with telehealth
provision, factors supporting or hindering telehealth provision in SNFs, and telehealth tools and technologies for
patients with ADRD. This application is innovative because it leverages a quasi-experimental approach to
estimate the causal effect of telehealth use, as well as a mixed methods approach to provide nuanced insights
into telehealth provision in SNFs, including current and emerging uses of telehealth in SNFs for patients with
ADRD. The proposed research is significant because it will provide new, critical evidence on the impact of
telehealth use for SNF patients, with a focus on patients with ADRD and on how telehealth is provided to patients
with ADRD, which may inform telehealth coverage policies and targeting of telehealth investments in PAC. This
K01
investigator
patients
Award will provide Dr. Yu with the training and mentoring needed to become an R01-funded independent
leading a research program on telehealth use for older adults in PAC settings, with a focus on
with ADRD.
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