Outcomes, Satisfaction, and Costs of a Rheumatology Telemedicine Program A Longitudinal Evaluation
Outcomes, Satisfaction, and Costs of a Rheumatology Telemedicine Program A Longitudinal Evaluation
复制标题
DOI：
10.1097/rhu.0000000000000778
复制
发表时间：
2019-01-01
影响因子：
3.4
通讯作者：
Caplan, Liron
中科院分区：
文献类型：
--
作者：
Wood, Patrick R.;Caplan, Liron
目的：由于地理障碍，患有炎症性关节炎（IA）的农村退伍军人缺乏医疗服务。远程医疗（TM）在缓解这些差距方面具有很大的前景。我们已经前瞻性地测量patientcentered数据周围的TM护理程序在联邦卫生系统和比较这些与常规护理（UC）。方法：退伍军人与以前建立IA入组TM后续。在进入该计划之前和之后纵向收集的数据包括患者指数数据常规评估3（RAPID-3）、自付访视费用和旅行距离以及患者满意度工具。记录人口统计学。类似的数据收集在一个方便的样本同时IA患者接受UC.Results：85例患者进行了观察，其中25接受TM护理和60接受UC。基线时，两组之间的人口统计学、满意度评分或RAPID-3无差异。横断面基线数据的单变量线性回归表明，RAPID-3（β = -0.64/10分，p = 0.01）、距离（β = -0.19/100英里，p = 0.02）和费用（β = -0.37/100美元，p = 0.05）可预测满意度量表评分。多变量模型表明距离（β = -0.17/100英里，p = 0.02）和RAPID-3（β = -0.47/10分，p < 0.03）均为访视满意度的预测因子。通过TM进行纵向随访，（Delta= 0.03，p = 0.94）和RAPID-3（Delta = 0.27，p = 0.89）在TM患者中与基线相似，而（Delta= -384.8英里/次，p < 0.01）和访视费用（Delta = -113.8美元/次，p < 0.01）。通过TM提供护理的患者报告结局与UC相似，可显著节省成本和距离。在设计护理模式时应考虑以患者为中心的因素，如距离护理，因为它们似乎与疾病控制一起推动患者满意度。
Objectives: Rural veterans with inflammatory arthritis (IA) lack medical access because of geographic barriers. Telemedicine (TM) holds great promise in relieving these disparities. We have prospectively measured patientcentered data surrounding a TM care program at a federal health system and compared these with usual care (UC).Methods: Veterans with previously established IA were enrolled in TM follow-up. Data collected longitudinally before and after entering the program included Routine Assessment of Patient Index Data 3 (RAPID-3), out-of-pocket visit costs and distances traveled, and patient satisfaction instruments. Demographics were recorded. Similar data were collected on a convenience sample of concurrent IA patients receiving UC.Results: Eighty-five patients were observed, including 25 receiving TM care and 60 receiving UC. No differences in demographics, satisfaction scores, or RAPID-3 were noted at baseline between groups. Univariate linear regression of cross-sectional baseline data suggests satisfaction instrument scores were predicted by RAPID-3 (beta = -0.64/ 10 points, p = 0.01), as well as distance (beta = -0.19/ 100 miles, p = 0.02) and cost (beta = -0.37/$ 100, p = 0.05). A multivariate model indicates both distance (beta = -0.17/ 100 miles, p = 0.02) and RAPID-3 (beta = -0.47/ 10 points, p < 0.03) were predictors for visit satisfaction. In longitudinal follow-up via TM, satisfaction (Delta= 0.03, p = 0.94) and RAPID-3 (Delta = 0.27, p = 0.89) remained similar to baseline among TM patients, whereas distance traveled (Delta= -384.8 miles/ visit, p < 0.01) and visit costs (Delta = -$ 113.8/ visit, p < 0.01) were reduced.Conclusions: Patient-reported outcomes for care delivered via TM were similar to UC, with significant cost and distance savings. Patient-centered factors such as distance to care should be considered in design care delivery models, as they appear to drive patient satisfaction in conjunction with disease control.