The Use of Telemedicine in the Care of Nursing Home Residents with Alzheimer’s Disease and Related Dementias after National Telemedicine Expansion in 2020

From 2020 to 2023, infectious disease and related health conditions have devastated nursing home residents in the US, nearly half of whom are diagnosed with Alzheimer's and other related dementias (ADRD). To limit resident exposure to infection and expand safe access to desperately-needed care from physicians and advanced practice providers, Medicare dropped previously tight restrictions and temporarily allowed SNFs to broadly use telemedicine to obtain care for residents. Dropping these restrictions helped facilitate a rapid adoption of telemedicine in SNFs, from <1% of SNFs billing for any telemedicine services in Oct-Dec 2019 to 55% in Apr- May 2020. Telemedicine has long been regarded as a promising, but underused, delivery innovation for SNFs addressing two major gaps in care. First, SNF clinicians are not always onsite, so medical issues that present during off-hours are often addressed by transferring patients, often unnecessarily, to the emergency department. Second, due to both financial and logistic reasons it is very difficult for SNF residents to obtain specialty care, including specialties critical those with ADRD like neurology or psychiatry. A limited literature suggests that telemedicine can bridge both of these care gaps, but more rigorous evidence is needed. In 2021, understanding the adoption and clinical impact of SNF telemedicine for the vulnerable population of older adults with ADRD has new urgency.
We propose to use Medicare claims, the Minimum Data Set and a national survey on SNF telemedicine implementation to answer the following specific aims:
1) Evaluate the patient-level association of SNF adoption of telemedicine in 2020 with health care use and clinical outcomes for SNF residents with and without ADRD.
2) Use group-based trajectory models to characterize 2020-2021 SNF-level patterns of telemedicine use (e.g., sustaining vs. de-adopting) and SNF characteristics associated with different trajectories.
3) Survey a national sample of SNFs, stratified by their trajectories measured in Aim 2, to assess facility leadership perceptions of telemedicine use and telemedicine implementation strategies.
Understanding how SNFs have used telemedicine and its association with clinical outcomes is essential to inform how Medicare and state Medicaid programs should regulate and promote telemedicine use in SNFs. Our findings will also help guide clinicians who care for SNF residents with ADRD on the clinical impact associated with telemedicine use and how it is being used nationally.

Grant Number: 7R01AG075507-05
NIH Institute/Center: NIH
Principal Investigator: Michael Barnett