Objectives

Prior to COVID-19, levels of adoption of telehealth were low in the U.S., though they exploded during the pandemic. Following the pandemic, it will be critical to identify the characteristics that were associated with adoption of telehealth prior to the pandemic as key drivers of adoption and outside of a public health emergency.

Materials and methods

We examined three data sources: The American Telemedicine Association’s 2019 state telehealth analysis, the American Hospital Association’s 2018 annual survey of acute care hospitals and its Information Technology Supplement. Telehealth adoption was measured through five telehealth categories. Independent variables included seven hospital characteristics and five reimbursement policies. After bivariate comparisons, we developed a multivariable model using logistic regression to assess characteristics associated with telehealth adoption.

Results

Among 2923 US hospitals, 73% had at least one telehealth capability. More than half of these hospitals invested in telehealth consultation services and stroke care.

Non-profit hospitals, affiliated hospitals, major teaching hospitals, and hospitals located in micropolitan areas (those with 10-50,000 people) were more likely to adopt telehealth.

In contrast, hospitals that lacked electronic clinical documentation, were unaffiliated with a hospital system, or were investor-owned had lower odds of adopting telehealth. None of the statewide policies were associated with adoption of telehealth.

Conclusions

Telehealth policy requires major revisions soon, and we suggest that these policies should be national rather than at the state level. Further steps as incentivizing rural hospitals for adopting interoperable systems and expanding RPM billing opportunities will help drive adoption, and promote equity.

中文翻译：

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美国医院的远程医疗：州级报销政策不再影响采用率

目标

在 COVID-19 之前，美国采用远程医疗的水平很低，尽管在大流行期间出现了爆炸式增长。在大流行之后，确定在大流行之前与采用远程医疗相关的特征作为采用的关键驱动因素和公共卫生紧急情况之外的特征将是至关重要的。

材料和方法

我们检查了三个数据源：美国远程医疗协会 2019 年州远程医疗分析、美国医院协会 2018 年急症医院年度调查及其信息技术补充。远程医疗的采用是通过五个远程医疗类别来衡量的。自变量包括七个医院特征和五个报销政策。双变量比较后，我们开发了一个多变量模型，使用逻辑回归来评估与远程医疗采用相关的特征。

结果

在 2923 家美国医院中，73% 的医院至少具备一项远程医疗能力。这些医院中有一半以上投资于远程医疗咨询服务和中风护理。

非营利性医院、附属医院、主要教学医院和位于小城市地区（拥有 10-50,000 人）的医院更有可能采用远程医疗。

相比之下，缺乏电子临床文件、不隶属于医院系统或投资者所有的医院采用远程医疗的几率较低。全州范围内的政策均与远程医疗的采用无关。

结论

远程医疗政策需要尽快进行重大修订，我们建议这些政策应该是全国性的，而不是州一级的。激励农村医院采用可互操作系统和扩大 RPM 计费机会等进一步措施将有助于推动采用并促进公平。