Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study.
Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study.
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DOI：
10.2196/24118
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发表时间：
2021-05-05
影响因子：
2.2
通讯作者：
Romaire M
中科院分区：
文献类型：
--
作者：
Haque SN;DeStefano S;Banger A;Rutledge R;Romaire M
远程医疗有潜力帮助农村地区的个人克服地理障碍并改善获得护理的机会。需要探索影响关键医院实施和使用远程医疗的因素。本研究的目的是了解影响美国一些前沿关键医院接受和使用远程医疗的因素。这项工作是对医疗保险和医疗补助服务中心资助的示范计划进行更大规模评估的一部分，该计划旨在扩大边境关键医院医疗保险受益人服务的基于成本的报销。我们的样本是蒙大拿州、内华达州和北达科他州的 8 家关键医院，它们实施了该演示的远程医疗方面。我们审查了示范项目的申请和进度报告，并进行了实地考察。我们使用半结构化讨论指南来促进与临床、行政和信息技术人员的对话。我们使用 NVivo 软件（QSR International）对采访笔记进行编码，然后分析主题。有几个因素影响了关键医院中远程医疗的实施和使用，包括工作流程和基础设施的改变以及医生的接受度和可用性。与会者还将技术援助和实施支持视为支持因素。前沿关键医院可以采用远程医疗来克服诸如与专科医生的距离和劳动力挑战等挑战。远程医疗可用于提供者与患者以及提供者与提供者之间的互动，以改善获得护理的机会、消除障碍并提高质量。然而，远程医疗改善结果的能力受到工作流程和基础设施变化、从业者接受度和可用性以及融资等因素的限制。
Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing.
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影响因子：
--
作者：
Campagna, M;Naka, F;Lu, J
通讯作者：
Lu, J
DOI：
10.1177/1078390317717330
发表时间：
2018-05-01
影响因子：
2
作者：
Baird, Martha B.;Whitney, Lucinda;Caedo, Cassie E.
通讯作者：
Caedo, Cassie E.
影响因子：
1.9
作者：
James, Hector E.
通讯作者：
James, Hector E.
DOI：
10.1186/s12969-017-0184-y
发表时间：
2017-07-11
期刊：
Pediatric rheumatology online journal
影响因子：
--
作者：
Bullock DR;Vehe RK;Zhang L;Correll CK
通讯作者：
Correll CK
影响因子：
4.7
作者：
Kreofsky, Beth L. H.;Blegen, R. Nicole;Demaerschalk, Bart M.
通讯作者：
Demaerschalk, Bart M.