University of Missouri School of Medicine researchers have received a $3.9 million grant from the federal Health Resources and Service Administration to launch a new center focused on improving telehealth in rural communities.
The new Center for Telehealth Research and Policy (C-TRaP) will examine how telehealth is used in rural areas, what barriers remain and how policies can be shaped to improve care.
Telehealth use has surged in recent years. According to the Missouri Telehealth Network, 15,911 MO HealthNet beneficiaries had 49,557 telehealth visits in 2017, the most recent year with available data — a tenfold increase in services since 2010 and nearly four times as many patients.
While that growth has expanded access, lead researcher Mirna Becevic said major challenges remain.
“We are looking at effectiveness and outcomes — the use patterns of patients, no-show rates, readmission rates for the hospital and overall utilization of the health care system,” said Becevic, who will direct the center. “Are patients using telehealth more? Are they using it for outpatient visits? Depending on their diagnosis, are they going to the ER or being hospitalized? Those are the kinds of questions we want to answer.”
Becevic said inconsistent insurance reimbursement policies, poor integration into clinic workflows and limited research on rural patients are among the biggest obstacles.
Most existing studies have focused on direct-to-consumer telehealth that typically allows patients to access healthcare services using electronic media without a prior doctor-patient relationship. C-TRaP will instead study traditional telehealth, where a patient first sees a primary care provider and, if a specialist is needed, receives a referral for a video consultation. The specialist’s notes are then shared with the primary provider — a model most often used by rural patients.
The center will begin several projects in its first year. One will test remote monitoring tools for patients with congestive heart failure. After hospital discharge, patients will use devices at home to track blood pressure, weight and temperature. That information will be sent directly to hospitals, allowing care teams to intervene when necessary. Becevic said the goal is to reduce hospital readmissions by as much as 40%.
Another project will study how Medicaid patients in rural Missouri used telehealth before and after pandemic-era policy changes.
Researchers will also use artificial intelligence to analyze large amounts of data, including images, text and audio. The goal is to better understand how virtual continuing education for clinicians influences prescribing behavior, care delivery and patient outcomes.
“One of the things that is important for us to find out is those facilitators and barriers — what’s working well and what doesn’t,” Becevic said. “We see a lot of early adopters, and our intention is to study them and see how their success can be applied to other institutions looking to expand or start new telehealth programs.”
The five-year grant will support about 15 researchers working on projects at MU and partner institutions.
