Abstract
OBJECTIVE: To examine telemedicine use among nursing home (NH) residents with Alzheimer disease and related dementias (ADRD) and the associations with NH characteristics. DESIGN: Observational study. SETTING AND PARTICIPANTS: 2020-2021 Minimum Data Set 3.0, Medicare datasets, and Nursing Home Compare data were linked. A total of 10,810 NHs were identified. METHODS: The outcome variable was the percentage of residents with ADRD who used telemedicine in an NH in a quarter. The main independent variables were NH racial and ethnic compositions (ie, percentages of Black and Hispanic residents) and NH rurality. A set of linear models with NH random effects were estimated. The analysis was stratified by COVID-19 pandemic stages, including the beginning of the pandemic [second quarter of 2020 (2020 Q2)], before and after the widespread of the COVID-19 vaccine (ie, 2020 Q3-2021 Q1 and 2021 Q2-2021 Q4). RESULTS: The proportion of residents with ADRD in NHs who had telemedicine use declined from 35.0% in 2020 Q2 to 9.3% in 2021 Q4. After adjusting for other NH characteristics, NHs with a high proportion of Hispanic residents were 2.7 percentage points more likely to use telemedicine for residents with ADRD than those with a low proportion during 2021 Q2-2021 Q4 (P < .001), whereas NHs with a high proportion of Black residents were 1.5 percentage points less likely to use telemedicine than those with a low proportion (P < .01). Additionally, compared with metropolitan NHs, rural NHs were 6.4 percentage points less likely to use telemedicine in 2020 Q2 (P < .001), but 5.9 percentage points more likely to use telemedicine during 2021 Q2-2021 Q4 (P < .001). We also detected the relationship between telemedicine use and other NH characteristics, such as NH quality, staffing level, and Medicaid-pay days. CONCLUSIONS AND IMPLICATIONS: The proportion of residents with ADRD in NHs who had telemedicine use decreased during the pandemic. Telemedicine could improve health care access for NHs with a high proportion of Hispanic residents and NHs in remote areas. Future studies should investigate how telemedicine use affects the health outcomes of NH residents with ADRD.