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The Effects Of Telemedicine on Health Outcomes, Costs, and Perceptions of Care Delivery in In-Center Hemodialysis

Award Number: R01DK128209
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 05/20/2021
PERIOD OF PERFORMANCE END DATE: 04/30/2027

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The Effects Of Telemedicine on Health Outcomes, Costs, and Perceptions of Care Delivery in In-Center Hemodialysis - Approximately 750,000 adults in the United States (US) have end-stage kidney disease (ESKD), where they require either dialysis or a kidney transplant in order to survive. Although in-center hemodialysis (HD) is the most common treatment for ESKD, it is associated with extremely high costs and poor health outcomes. Advances in communications technologies, combined with broad access to these technologies, have led many US policymakers and healthcare providers to champion telehealth as a way to improve access to care and to reduce costs in various healthcare settings, including the monitoring and treatment of patients with chronic disease. Until recently, regulatory barriers have effectively prohibited physicians from using telemedicine to deliver in-center HD care. This changed in March 2020, when emergency waivers issued in response to the COVID-19 pandemic allowed nephrology practitioners (nephrologists and advanced practitioner providers (APPs)) to deliver up to 4 encounters per month to HD patients via telemedicine. In the context of existing care gaps and inefficiencies associated with the current system of physician reimbursement for dialysis care, there are several ways in which telemedicine might improve dialysis care. Medicare’s 3-tiered monthly capitated payment (MCP) system of reimbursing physicians for in-center HD care encourages nephrologists to see patients up to 4 times per month, often with little or no benefits resulting from frequent visits. Paradoxically, patients most likely to benefit from closer nephrology supervision (such as those recently discharged from the hospital) are, on average, less likely to be seen frequently. By reducing the amount of time nephrologists spend traveling to dialysis facilities to see patients frequently, telehealth could make it easier for practitioners to align their rounding schedules with the needs of their patients and could reduce costs associated with time spent traveling. Alternatively, if telehealth is used to replace interactions that are better conducted face-to-face (such as vascular access examinations or dry weight assessments) or to see patients frequently who don’t require closer supervision, then the adoption of telehealth could impair health and increase costs. We propose 3 specific aims that will leverage the recent increase in the use of telehealth following the COVID-19 outbreak in order to assess the uptake of telemedicine for in-center maintenance HD care, to understand whether the use of telehealth for in-center HD practitioner care affects healthcare costs and patient health outcomes, and to describe patient and provider perspectives on telehealth in in-center HD. We propose a mixed-methods approach that includes secondary analyses of several large administrative dialysis databases which we will complement with semi-structured interviews of nephrology practitioners. When the current emergency waivers granting broad access to telehealth end, policy makers and the clinical community will need to determine the future role of telemedicine for in-center HD care. Our findings will inform these decisions by providing crucial information about the benefits and potential dangers of telemedicine in this setting.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2025	BAYLOR COLLEGE OF MEDICINE	1 BAYLOR PLZ	HOUSTON	TX	77030	HARRIS	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	5	2/4/2026	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = $519,397 )
2025	2025	BAYLOR COLLEGE OF MEDICINE	1 BAYLOR PLZ	HOUSTON	TX	77030	HARRIS	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	5	8/20/2025	NON-COMPETING CONTINUATION	$519,397
														Subtotal = $519,397

Issue Date FY: 2024 ( Subtotal = $537,879 )
2024	2024	BAYLOR COLLEGE OF MEDICINE	1 BAYLOR PLZ	HOUSTON	TX	77030	HARRIS	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	6/19/2024	NON-COMPETING CONTINUATION	$537,879
														Subtotal = $537,879

Issue Date FY: 2023 ( Subtotal = $613,654 )
2023	2023	BAYLOR COLLEGE OF MEDICINE	1 BAYLOR PLZ	HOUSTON	TX	77030	HARRIS	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	6/16/2023	NON-COMPETING CONTINUATION	$613,654
														Subtotal = $613,654

Issue Date FY: 2022 ( Subtotal = $655,595 )
2022	2022	BAYLOR COLLEGE OF MEDICINE	ONE BAYLOR PLAZA	HOUSTON	TX	77030	HARRIS	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	5/17/2022	NON-COMPETING CONTINUATION	$655,595
														Subtotal = $655,595

Issue Date FY: 2021 ( Subtotal = $712,357 )
2021	2021	BAYLOR COLLEGE OF MEDICINE	ONE BAYLOR PLAZA	HOUSTON	TX	77030	HARRIS	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	5/25/2021	NEW	$712,357
														Subtotal = $712,357

Grand Total All Awards = $3,038,882

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The Effects Of Telemedicine on Health Outcomes, Costs, and Perceptions of Care Delivery in In-Center Hemodialysis

Award Number: R01DK128209

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 05/20/2021

PERIOD OF PERFORMANCE END DATE: 04/30/2027

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