Evaluating the role of telehealth in patients with end stage kidney disease (ESKD)

7. PROJECT SUMMARY
The 60 million rural dwellers across the United States are older, more likely to live in poverty, and more likely to
be either underinsured or uninsured compared to their urban counterparts. Moreover, the 240,000 rural
patients with end stage kidney disease (ESKD) have less access to nephrology care, are less likely to finish
pre-kidney transplant evaluation, and are less likely to undergo kidney transplantation.
Telehealth is uniquely positioned to overcome geographic barriers of rural America by capitalizing on electronic
information and telecommunication technologies. Yet telehealth is underutilized among rural patients in
general, and little is known about how geography, resources, and distance to healthcare facilities contribute to
access to care, outcomes, and quality of life for rural patients with ESKD. A comprehensive study of utilization,
cost-effectiveness, and patient and provider preferences would be an important step in expanding telehealth
policies specifically aimed to care for the rural ESKD population.
We propose the following specific aims: (1) to assess the costs, utilization, and outcomes associated with
telehealth for rural patients with ESKD; (2) to compare telehealth provision of ESKD care to standard in-office
care in the rural ESKD population using model-based cost-effectiveness analysis; and (3) to understand
facilitators and barriers of using telehealth from the perspective of patients and providers.
A detailed training plan for Joel T. Adler, MD, MPH, is outlined in this proposal. In brief, it includes in-depth
coursework to extend and expand Dr. Adler’s research skills, a practicum experience with the RURAL (Risk
Underlying Rural Areas Longitudinal) Cohort study in the southern rural United States, and a mentorship plan
jointly prepared by the principal investigator and a team with expertise in kidney disease, health services
research, qualitative research, cost-effectiveness analysis, and the mentorship of junior clinician-scientists.
This will help the candidate meet the following career goals: (1) gain state of the art expertise in large claims
database, geographic information systems, cost-effectiveness, and qualitative research, (2) apply for and
obtain R01 grant funding, and (3) transition to academic independence.
When completed, Dr. Adler will have learned the perspectives of rural patients with EKSD and providers on
telehealth that will be methodically crucial in designing pilot studies that inform R01 proposals to increase
accessibility and utilization of telehealth on a population-health level for rural patents with ESKD. These efforts
will culminate in a comprehensive understanding of the role of telehealth in caring for rural patients with ESKD
by economic assessment of its utilization, a cost-effectiveness analysis for implementation on a wider scale,
and learning how these align with patient and provider preferences to inform future policy regarding telehealth
utilization and reimbursement.

Grant Number: 5K08HS028476-04
NIH Institute/Center: AHRQ
Principal Investigator: Joel Adler