COVID19 Pandemic: Natural Experiment in Rural Cancer Care Telemedicine Capacity Building

The COVID-19 pandemic has catalyzed an unprecedented need to deliver ongoing care for cancer and other chronic conditions remotely. Telemedicine has long been touted as an underused, but promising, mode of delivering care to rural areas. Successful care delivery models, such as teleconsultation and telementoring, have become more prevalent in the past decade, yet are underutilized in rural areas. Assessing telemedicine capacity within geographic areas is critical for regional planning to serve rural populations' cancer care needs. Telemedicine is a focus of the Rural Supplement to the CCSG for the Norris Cotton Cancer Center (NCCC), with a community-partnered environmental scan of telemedicine capacity underway within our catchment area (NH/VT). Within weeks of confirmed COVID-19 patients in our region, NCCC providers from most ambulatory services transitioned to televisits for a large portion of patients. This extremely rapid expansion of telemedicine services, arising from a public health crisis, will have unknown effects on telemedicine capacity post-pandemic. A persistent increase in capacity and/or readiness to sustain telemedicine care delivery may be a positive unintended consequence of this unprecedented population-wide social isolation. NCCC's precipitous shift of health care delivery to remote modes, leveraged with our ongoing catchment area work, provides a unique opportunity to conduct a natural experiment in telemedicine capacity-building. Using a mixed methods approach to evaluate the multilevel impact of this natural experiment we will test underlying capacity for telemedicine and its sustainability, addressing: a) mobilization of information technology resources; b) rapid development of service delivery pathways; c) clinical information integration; d) attitudinal shifts of patients, providers and health system managers, and the interplay of telemedicine with social determinants of health for our cancer population; and e) payment models. Our specific aims are: Aim 1) Document changes in telemedicine capacity, use, and outcomes across the cancer care continuum by gathering data at multiple levels including patient, provider, health system and policy/contextual; Aim 2) Evaluate the factors associated with sustained telemedicine capacity, use, and outcomes following the COVID-19 pandemic based on Aim 1 multilevel data; Aim 3) Collaboratively document and share lessons learned regarding the impact of the COVID-19 pandemic on telemedicine cancer care delivery with other cancer centers funded to study telemedicine through the CCSG supplement mechanism.