Association Between Telemedicine Use in Nonmetropolitan Counties and Quality of Care Received by Medicare Beneficiaries With Serious Mental Illness

Wang, Bill; Huskamp, Haiden A.; Rose, Sherri; Busch, Alisa B.; Uscher‐Pines, Lori; Raja, Pushpa; Mehrotra, Ateev

doi:10.1001/jamanetworkopen.2022.18730

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…[21][22][23] Our results are also consistent with prior observational studies that found that patients had more visits if they lived in rural counties with more telemedicine practices or were cared for by health centers with greater telemedicine use. 25,36 Given the use of a national sample, including both rural and urban patients, and a larger set of quality health care use measures, we believe our study offers the largest, most generalizable evidence yet on the clinical implications of telemedicine for the care of mental illness.…”

Section: Discussionmentioning

confidence: 97%

“…This finding is consistent with several prior studies that also found that telemedicine use was associated with more ED visits or hospitalizations. 25 , 37 , 38 , 39 We also recognize that hospitalizations and ED visits for all indications fell sharply early in the pandemic. In that context, one must be cautious in interpreting relative changes in hospitalizations and ED use.…”

Section: Discussionmentioning

confidence: 98%

“… 24 One observational study found that greater telemedicine use for patients with SMI was associated with modest increases in regular contact with mental health specialists. 25 Prior research has been limited by small sample sizes, modest use of telemedicine compared with its level of adoption during the pandemic, or a focus only on residents in rural areas. To address these gaps in knowledge, we investigated the implications of greater telemedicine use by mental health specialty practices during the COVID-19 pandemic for changes in outpatient mental health visits and quality of care among Medicare beneficiaries with SMI.…”

Section: Introductionmentioning

confidence: 99%

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Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness

Wilcock,

Huskamp,

Busch

et al. 2023

JAMA Health Forum

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ImportanceDuring the COVID-19 pandemic, a large fraction of mental health care was provided via telemedicine. The implications of this shift in care for use of mental health service and quality of care have not been characterized.ObjectiveTo compare changes in care patterns and quality during the first year of the pandemic among Medicare beneficiaries with serious mental illness (schizophrenia or bipolar I disorder) cared for at practices with higher vs lower telemedicine use.Design, Setting, and ParticipantsIn this cohort study, Medicare fee-for-service beneficiaries with schizophrenia or bipolar I disorder were attributed to specialty mental health practices that delivered the majority of their mental health care in 2019. Practices were categorized into 3 groups based on the proportion of telemental health visits provided during the first year of the pandemic (March 2020-February 2021): lowest use (0%-49%), middle use (50%-89%), or highest use (90%-100%). Across the 3 groups of practices, differential changes in patient outcomes were calculated from the year before the pandemic started to the year after. These changes were also compared with differential changes from a 2-year prepandemic period. Analyses were conducted in November 2022.ExposurePractice-level use of telemedicine during the first year of the COVID-19 pandemic.Main Outcomes and MeasuresThe primary outcome was the total number of mental health visits (telemedicine plus in-person) per person. Secondary outcomes included the number of acute hospital and emergency department encounters, all-cause mortality, and quality outcomes, including adherence to antipsychotic and mood-stabilizing medications (as measured by the number of months of medication fills) and 7- and 30-day outpatient follow-up rates after discharge for a mental health hospitalization.ResultsThe pandemic cohort included 120 050 Medicare beneficiaries (mean [SD] age, 56.5 [14.5] years; 66 638 females [55.5%]) with serious mental illness. Compared with prepandemic changes and relative to patients receiving care at practices with the lowest telemedicine use: patients receiving care at practices in the middle and highest telemedicine use groups had 1.11 (95% CI, 0.45-1.76) and 1.94 (95% CI, 1.28-2.59) more mental health visits per patient per year (or 7.5% [95% CI, 3.0%-11.9%] and 13.0% [95% CI, 8.6%-17.4%] more mental health visits per year, respectively). Among patients of practices with middle and highest telemedicine use, changes in adherence to antipsychotic and mood-stabilizing medications were −0.4% (95% CI, −1.3% to 0.5%) and −0.1% (95% CI, −1.0% to 0.8%), and hospital and emergency department use for any reason changed by 2.4% (95% CI, −1.5% to 6.2%) and 2.8% (95% CI, −1.2% to 6.8%), respectively. There were no significant differential changes in postdischarge follow-up or mortality rates according to the level of telemedicine use.Conclusions and RelevanceIn this cohort study of Medicare beneficiaries with serious mental illness, patients receiving care from practices that had a higher level of telemedicine use during the COVID-19 pandemic had more mental health visits per year compared with prepandemic levels, with no differential changes in other observed quality metrics over the same period.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness

Wilcock,

Huskamp,

Busch

et al. 2023

JAMA Health Forum

Self Cite

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show abstract

“…The effect of telemedicine use on the number of visits for privately insured patients in this study parallels the trends reported in other studies, which have looked at Medicaid and Medicare patients and found an association between higher telemedicine availability and an increase in visit rates. 20 , 21 This could be beneficial for people with chronic mental health conditions, who, despite higher morbidity, have fewer routine checkup visits, experience delayed diagnoses, and have higher treatment dropout rates than the general population. 9 , 10 , 11 …”

Section: Discussionmentioning

confidence: 99%

“… 17 , 18 , 19 However, outside of clinical trials, evidence for patients with mental illness is limited, with research focused primarily on Medicare and Medicaid beneficiaries. 20 , 21 …”

Section: Introductionmentioning

confidence: 99%

Effect of Telemedicine Use on Medical Spending and Health Care Utilization: A Machine Learning Approach

Jamal

2023

AJPM Focus

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Effect of telemedicine use on medical spending and health care utilization among patients with gastrointestinal cancer

Endo,

Woldesenbet,

Tsilimigras

et al. 2024

Journal of Gastrointestinal Surgery

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Association Between Telemedicine Use in Nonmetropolitan Counties and Quality of Care Received by Medicare Beneficiaries With Serious Mental Illness

Cited by 10 publications

References 24 publications

Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness

Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness

Effect of Telemedicine Use on Medical Spending and Health Care Utilization: A Machine Learning Approach

Effect of telemedicine use on medical spending and health care utilization among patients with gastrointestinal cancer

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