Description
- Abstract:
- While virtual care had been growing in capability and use in preceding years, the onset of COVID-19 greatly accelerated these trends. Telemedicine and patient portals possess the potential to improve care management but concerns persist as to their effectiveness as complements and substitutes to in-person care. This dissertation uses data from Medicaid administrative claims, an Electronic Health Record, and a statewide Health Information Exchange (HIE) to understand how COVID-19 (and the ensuing rise in virtual care use), influenced care utilization, health status, care costs, and racial disparities in health and healthcare. Chapter 1 uses administrative claims data from a large Massachusetts Medicaid ACO to understand how FQHC-level telemedicine use affects care engagement, costs, and health quality amongst Federally Qualified Health Center (FQHC) patients with multiple chronic conditions. Chapter 2 uses data from Rhode Island’s HIE to investigate the relationship between patient-level patient portal usage and care engagement and health quality amongst Rhode Island patients. Given the inequities in virtual care access and use, disparities in outcomes may widen with increased overall adoption (an occurrence known as “The Digital Divide”). Thus, Chapter 3 uses both aforementioned datasets to understand how these policies differentially affect racial sub-groups. To investigate these relationships, this dissertation leverages a variety of econometric techniques including Difference-in-Differences (Chapters 1 & 2), and Triple Difference (Chapter 3) models. Ultimately, these chapters find that increased usage of these technologies led to increased care engagement while not negatively affecting health and direct health care costs. Further, equity-driven virtual care rollout did not widen racial disparities, but target initiatives may be required to ensure marginalized groups have equal access to these technologies. While the emergent COVID-19 threat has lessened, virtual care has demonstrated staying power. Understanding the types of care that can be administered remotely is crucial for policymakers, payers, providers, and patients as they figure out virtual care’s ongoing role in the US health landscape.
- Notes:
- Thesis (Ph. D.)--Brown University, 2024
Citation
Jones, Nicholas Woodson,
"Estimating the Effects of Virtual Care Usage on Health, Care Utilization, Costs, and Racial Disparities"
(2024).
Health Services, Policy & Practice Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://repository.library.brown.edu/studio/item/bdr:ey2ufcdj/
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Collection:
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Health Services, Policy & Practice Theses and Dissertations
Theses and Dissertations for the Health Services, Policy & Practice department....