ORCID ID

0009-0005-4160-8420

Graduation Date

Summer 8-9-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Health Services Research, Administration, and Policy

First Advisor

Jungyoon Kim

Second Advisor

Hongmei Wang

Third Advisor

Jane Potter

Fourth Advisor

Paul Estabrooks

MeSH Headings

Telemedicine, Annual Wellness Visits, Aging, Implementation Science, Primary Health Care

Abstract

Telehealth, rapidly adopted during the pandemic, has shown its usefulness and limitations, yet was not designed with older adults in mind. This dissertation encompasses three interconnected studies exploring telehealth utilization for Medicare Annual Wellness Visits (AWVs) among older adults, provider perspectives on telehealth AWVs, and the impact of teleconferencing on primary care providers' knowledge and confidence in geriatric care. The objectives are to determine patient characteristics using telehealth AWV (study 1), understand provider perspectives on telehealth AWV (study 2), and evaluate the effectiveness of geriatrics education through telehealth (study 3). Study 1 investigates the changes in AWV utilization among 18,405 patients aged 65 and older across 11 Patient-Centered Medical Homes clinics in Nebraska before and during the pandemic. Findings indicate that females, Hispanic patients, and those from larger clinics were more likely to adopt telehealth. In contrast, non-Hispanic Black patients and non-English speakers had lower odds of utilizing telehealth services, highlighting the need for targeted interventions to address these disparities. In Study 2, primary care providers’ perspectives on telehealth AWVs post-COVID-19 were explored using the Practical, Robust Implementation, and Sustainability Model through semi-structured interviews with 25 providers. Providers noted the advantages of telehealth in reducing transportation barriers, observing patients' home environments, and being efficient in time. However, challenges such as difficulties in cognitive and mobility assessments and limited physical interactions were significant, emphasizing the importance of comprehensive training, pre-visit coordination, staff support, and robust infrastructure. Study 3 evaluated the Extension for Community Healthcare Outcomes model on its Geriatrics telehealth training in enhancing knowledge, confidence, and practical application of geriatric care principles among 100 interprofessional primary care providers over 18 months. Participants reported high satisfaction and significant increases in knowledge and confidence in applying the 4Ms framework. Despite time constraints, participants highlighted the benefits of the case conference, including interdisciplinary collaboration, community resources, and discussions. These studies provide a multi-level and multi-method approach to comprehensively understand and improve telehealth utilization among older adults, providing a foundation for targeted interventions and policy changes.

Comments

Copyright 2024, the authors

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