PDF(Pubmed)
Abstract：
UNASSIGNED: Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth\'s impacts on SMI care outcomes is mixed, necessitating further investigation.
UNASSIGNED: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI.
UNASSIGNED: We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt).
UNASSIGNED: Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=-4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=-4.49; P<.001; z=-3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=-3.74; P<.001), and continuity of care after a high-risk event (z=-2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=-4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized.
UNASSIGNED: Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation-selected through a health equity lens-may improve quality of care among patients with SMI.
UNASSIGNED: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI.
UNASSIGNED: We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt).
UNASSIGNED: Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=-4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=-4.49; P<.001; z=-3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=-3.74; P<.001), and continuity of care after a high-risk event (z=-2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=-4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized.
UNASSIGNED: Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation-selected through a health equity lens-may improve quality of care among patients with SMI.
摘要：
■远程医疗的实施对于患有严重精神疾病（SMI）的人来说可能具有挑战性，这可能会影响他们的护理质量和健康结果。关于远程医疗对SMI护理结果的影响的文献好坏参半，需要进一步调查。
■我们研究了SMI患者在一段时间内采用设施级远程医疗对护理质量指标的影响。
■我们分析了2021年1月至2022年12月138个机构的退伍军人事务（VA）管理数据。我们进行了纵向混合效应回归，以确定设施级远程医疗就诊比例与SMI专业护理质量指标之间的关系：参与初级保健；在一系列精神卫生服务中获得和连续性护理，包括心理治疗或心理社会康复，针对SMI的强化门诊计划，和强化病例管理；以及高风险事件后精神卫生保健的连续性(例如，自杀企图）。
■远程医疗就诊比例较高的设施减少了SMI患者获得身心健康护理的机会和连续性（P<0.05）。较高的远程医疗采用率与初级保健参与度降低相关(z=-4.04；P<.001)，减少SMI特定强化病例管理的访问和连续性(z=-4.49；P<.001；z=-3.15；P<.002)，心理治疗和心理社会康复中护理连续性的降低（z=-3.74；P<.001），和高风险事件后护理的连续性（z=-2.46；P<0.01）。远程医疗摄取最初增加了对密集门诊的访问，但随着时间的推移并没有改善其连续性（z=-4.47；P<.001）。除了SMI特定的强化病例管理中的连续性（z=2.62；P<.009），随着远程医疗变得日常化，连续性并没有随着时间的推移而改善。
■尽管远程医疗在大流行期间帮助维持了医疗保健服务，远程医疗在某些SMI患者的护理质量方面可能存在权衡。这些数据表明，SMI特定的强化病例管理使用的参与策略可能保留了质量，并可能使其他设置受益。通过健康公平镜头选择的增强远程保健实施的策略可能会提高SMI患者的护理质量。
■我们研究了SMI患者在一段时间内采用设施级远程医疗对护理质量指标的影响。
■我们分析了2021年1月至2022年12月138个机构的退伍军人事务（VA）管理数据。我们进行了纵向混合效应回归，以确定设施级远程医疗就诊比例与SMI专业护理质量指标之间的关系：参与初级保健；在一系列精神卫生服务中获得和连续性护理，包括心理治疗或心理社会康复，针对SMI的强化门诊计划，和强化病例管理；以及高风险事件后精神卫生保健的连续性(例如，自杀企图）。
■远程医疗就诊比例较高的设施减少了SMI患者获得身心健康护理的机会和连续性（P<0.05）。较高的远程医疗采用率与初级保健参与度降低相关(z=-4.04；P<.001)，减少SMI特定强化病例管理的访问和连续性(z=-4.49；P<.001；z=-3.15；P<.002)，心理治疗和心理社会康复中护理连续性的降低（z=-3.74；P<.001），和高风险事件后护理的连续性（z=-2.46；P<0.01）。远程医疗摄取最初增加了对密集门诊的访问，但随着时间的推移并没有改善其连续性（z=-4.47；P<.001）。除了SMI特定的强化病例管理中的连续性（z=2.62；P<.009），随着远程医疗变得日常化，连续性并没有随着时间的推移而改善。
■尽管远程医疗在大流行期间帮助维持了医疗保健服务，远程医疗在某些SMI患者的护理质量方面可能存在权衡。这些数据表明，SMI特定的强化病例管理使用的参与策略可能保留了质量，并可能使其他设置受益。通过健康公平镜头选择的增强远程保健实施的策略可能会提高SMI患者的护理质量。
