The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study.
The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study.
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DOI：
10.1371/journal.pone.0190247
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Murto K
中科院分区：
文献类型：
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作者：
Lai L;Liddy C;Keely E;Afkham A;Kurzawa J;Abdeen N;Audcent T;Bromwich M;Brophy J;Carsen S;Fournier A;Fraser-Roberts L;Gandy H;Hui C;Johnston D;Keely K;Kontio K;Lamontagne C;Major N;O'Connor M;Radhakrishnan D;Reisman J;Robb M;Samson L;Sell E;Splinter W;van Stralen J;Venkateswaran S;Murto K
Champlain BASE™（通过电子咨询建立与专家的联系）是一种基于网络的异步电子通信服务，允许初级保健从业者 (PCP) 向专家提交“选择性”临床问题。对于成年人来说，PCP 表示获得专家建议的机会和及时性得到了改善，在高达 40% 的病例中避免了面对面的专家转诊，并且提供者满意度很高。确定将 eConsult 扩展到儿科环境是否会导致类似的措施改善医疗保健系统流程并提高成人的医疗服务提供者接受度。前瞻性观察队列研究。加拿大唯一一家三级护理学术儿科医院（2014 年 6 月至 16 日），为 120 万人提供服务。 1. PCP 已在使用 eConsult。 2.儿科专家志愿者提供正常工作量之外的服务。 3.因非急性护理情况而转诊的儿科患者（< 18 岁）。收集了专业服务的利用和获取、对 PCP 行动方案和转诊模式的影响以及基于调查的提供者满意度数据。来自 367 位 PCP 的 1064 个电子咨询请求得到了代表 14 个专业服务的 23 名儿科专家的答复。排名前三位的专科为：普通儿科 393 例（36.9%）、骨科 162 例（15.2%）和精神科 123 例（11.6%）。专家响应时间中位数为 0.9 天（范围 <1 小时至 27 天），大多数咨询 (63.2%) 需要 <10 分钟才能完成，21/21 (100%) 专家调查受访者报告工作量负担最小。对于 515/1064(48.4%) 的转介，PCP 收到了关于新的或额外的行动方案的建议； 391/1064(36.7%) 的转诊导致避免了面对面的专家就诊。在具有完整数据的 9 个专业中，与面对面转诊（132 天；95%CI：127-136）相比，电子咨询（1 天，95%CI：0.9-1.2）的中位等待时间显着缩短（p<0.001）。大多数 (>93.3%) PCP 认为 eConsult 对患者及其自身都非常有价值。所有专家调查受访者都表示电子咨询应该是一项持续的服务。与成人类似，eConsult 提高了 PCP 获得选择性儿科专家建议的机会和及时性，并影响他们的护理决策，同时报告了最终用户的高满意度。需要进一步研究来评估对资源利用和临床结果的影响。
Champlain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit “elective” clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction. To determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults. Prospective observational cohort study. Single Canadian tertiary-care academic pediatric hospital (June 2014–16) servicing 1.2 million people. 1. PCPs already using eConsult. 2.Volunteer pediatric specialists provided services in addition to their regular workload. 3.Pediatric patients (< 18 years-old) referred for none-acute care conditions. Specialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected. 1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services. The top three specialties represented were: General Pediatrics 393 cases (36.9%), Orthopedics 162 (15.2%) and Psychiatry 123 (11.6%). Median specialist response time was 0.9 days (range <1 hour-27 days), most consults (63.2%) required <10minutes to complete and 21/21(100%) specialist survey-respondents reported minimal workload burden. For 515/1064(48.4%) referrals, PCPs received advice for a new or additional course of action; 391/1064(36.7%) referrals resulted in an averted face-to-face specialist visit. In 9 specialties with complete data, the median wait-time was significantly less (p<0.001) for an eConsult (1 day, 95%CI:0.9–1.2) compared with a face-to-face referral (132 days; 95%CI:127–136). The majority (>93.3%) of PCPs rated eConsult as very good/excellent value for both patients and themselves. All specialist survey-respondents indicated eConsult should be a continued service. Similar to adults, eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions, while reporting high end-user satisfaction. Further study is warranted to assess impact on resource utilization and clinical outcomes.
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影响因子：
--
作者：
Angstman, Kurt B.;Adamson, Steven C.;Robrer, James E.
通讯作者：
Robrer, James E.
影响因子：
--
作者：
Callahan, CW;Malone, F;Person, DA
通讯作者：
Person, DA
影响因子：
4.2
作者：
Lee, Richard H.;Lyles, Kenneth W.;Colon-Emeric, Cathleen
通讯作者：
Colon-Emeric, Cathleen
影响因子：
1.2
作者：
Johnston, Donna L.;Murto, Kimmo;Lai, Lillian
通讯作者：
Lai, Lillian
影响因子：
4.7
作者：
Jaatinen, PT;Aarnio, P;Köymäri-Seilonen, T
通讯作者：
Köymäri-Seilonen, T