||5R01CA267990-02 Interpret this number
||University Of Utah
||Access, Utilization and Outcomes of Cancer Services in the Era of Telemedicine
Use of telehealth has skyrocketed since the start of the COVID-19 pandemic. Pre-pandemic, only 60,000 of the
63 million fee-for-service Medicare beneficiaries received a telehealth service each month compared to 24.5
million from March to October, 2020, with wide geographic variation in that uptake (e.g. 8.4% in South Dakota
to 47.6% in Massachusetts). This telehealth expansion comes at a time when the often-severe access issues
for rural individuals have become a focus for health policy and equity. Longer travel times for rural cancer
patients have been shown to negatively impact treatment regimens, RCT participation, and symptom
management. Multi-specialist teams are often required for comprehensive cancer care, making care
coordination in rural areas particularly challenging. These barriers have contributed to the widening gap in
cancer mortality between rural and urban patients. Measuring access to cancer care is a fundamental
component of both identifying gaps in access, as well as developing care delivery models to mitigate
disparities. Because telehealth transcends geographic proximity, it holds great promise for addressing rural
cancer care access inequities. Telehealth allows specialists to connect with geographically distant patients and
providers who otherwise would have had more restricted options for referral. With the expected persistence of
expanded telehealth following the COVID-19 pandemic, the time is now to develop new ways to measure
access to cancer care that integrate geospatial measures with telehealth and referral patterns in order to
improve equity in health care access and outcomes. Telehealth is now integral to rural cancer care in some
regions, yet where gaps are in its use and how inequities in access impact utilization and outcomes is
unknown. Only by measuring the new reality of cancer care access that includes telehealth, understanding
telehealth impacts on outcomes, and applying this evidence to “what if” scenarios/projections, can we begin to
harness and proactively direct the potential that telehealth has to reduce rural cancer disparities. This study will
take the critical and timely steps of developing measures of access nationally that incorporate telehealth,
identifying determinants of telehealth use in cancer care, testing effects of telehealth on cancer outcomes, and
analyzing the projected impact on equity in cancer care access and outcomes if telehealth use in cancer is
expanded, while considering differential effects based on the rural-urban continuum. To do this, we will use
national Medicare claims for telehealth utilization among cancer patients, Federal Communications
Commission (FCC) broadband data, and 2020 Census data for the entire U.S., to extend our prior geospatial
cancer care access work (R21CA212687) and population-based outcomes modeling with policy relevance.
Refining 2SVCA Method for Measuring Telehealth Accessibility of Primary Care Physicians in Baton Rouge, Louisiana.
, Alford-Teaster J.
, Onega T.
, Wang F.
Cities (London, England), 2023 Jul; 138, .
Disparities in spatial accessibility of primary care in Louisiana: From physical to virtual accessibility.
, Zeng Y.
, Liu L.
, Onega T.
Frontiers in public health, 2023; 11, p. 1154574.