Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19.
Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19.
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DOI：
10.1001/jamaoncol.2020.6982
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发表时间：
2021-04-01
期刊：
影响因子：
28.4
通讯作者：
Krzyzanowska MK
中科院分区：
文献类型：
--
作者：
Berlin A;Lovas M;Truong T;Melwani S;Liu J;Liu ZA;Badzynski A;Carpenter MB;Virtanen C;Morley L;Bhattacharyya O;Escaf M;Moody L;Goldfarb A;Brzozowski L;Cafazzo J;Chua MLK;Stewart AK;Krzyzanowska MK
在2019冠状病毒病（COVID-19）大流行期间，虚拟医疗（VC）能否在三级中心快速实施，服务能力和质量结果如何？这项队列研究的22 085 VC访问在一个单一的癌症中心建议的敏捷服务设计过程中实施VC的规模的可行性。这种方法保留了门诊病例，并保持了医疗质量的所有6个护理质量领域的护理质量，同时提供了很高的患者和医生的满意度。这些数据支持风险投资的价值主张，即保护系统容量，同时最大限度地减少大流行期间对患者护理的干扰。2019冠状病毒病（COVID-19）大流行加重了医疗资源的负担，并扰乱了癌症患者的护理。虚拟护理（VC）是一种潜在的解决方案。然而，很少有定量数据支持其迅速实施以及与服务能力和质量的积极联系。检查癌症中心范围内的虚拟护理计划应对COVID-19大流行的结果。这项队列研究应用了医院范围内的敏捷服务设计，以绘制差距并开发定制的数字解决方案，从而在公共资助的综合癌症中心实现大规模风险投资。数据收集自2020年3月23日至5月22日在加拿大安大略的一个高容量癌症中心。结果的措施是护理交付量，护理质量，病人和医生的经验，并节省成本的病人。VC解决方案于COVID-19疫情宣布后12天开发并推出。共进行了22085次VC访视（平均每天514次访视），占每日访视的68.4%（范围：18.8%-100%），而上市前为0.8%（P <0.001）。门诊量在部署后一个月恢复（每周3714-4091例患者），而化疗和放疗病例量（每周1943-2461例患者）始终保持稳定。没有观察到机构或省级护理质量指数的变化。共完成了3791项调查（3507名患者和284名从业人员）; 2207名患者（82%）和92名从业人员（72%）表示对VC总体满意。该计划的直接成本为202 537加元，患者的置换相关成本节省共计3 155 946加元。这些研究结果表明，在高容量癌症中心大规模实施VC可能是可行的。敏捷的服务设计方法能够保持门诊病例量和保持护理质量，同时提供高患者和从业人员的满意度。这些发现可能有助于指导后COVID-19时代的远程医疗转型。这项对一家公共资助的综合癌症中心的队列研究，考察了癌症中心范围内的虚拟护理计划应对COVID-19大流行的结果。
Can virtual care (VC) be rapidly implemented across a tertiary center during the coronavirus disease 2019 (COVID-19) pandemic, and what are service capacity and quality outcomes? This cohort study of 22 085 VC visits at a single cancer center suggests feasibility of an agile service design process for implementation of VC at scale. This approach preserved outpatient caseloads and maintained care quality in all 6 care-quality domains of care quality laid out by the Institute of Medicine while rendering high patient and practitioner satisfaction. These data support the value proposition of VC to safeguard system capacity, while minimizing the disruption to patient care during a pandemic. The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few quantitative data support its rapid implementation and positive associations with service capacity and quality. To examine the outcomes of a cancer center–wide virtual care program in response to the COVID-19 pandemic. This cohort study applied a hospitalwide agile service design to map gaps and develop a customized digital solution to enable at-scale VC across a publicly funded comprehensive cancer center. Data were collected from a high-volume cancer center in Ontario, Canada, from March 23 to May 22, 2020. Outcome measures were care delivery volumes, quality of care, patient and practitioner experiences, and cost savings to patients. The VC solution was developed and launched 12 days after the declaration of the COVID-19 pandemic. A total of 22 085 VC visits (mean, 514 visits per day) were conducted, comprising 68.4% (range, 18.8%-100%) of daily visits compared with 0.8% before launch (P < .001). Ambulatory clinic volumes recovered a month after deployment (3714-4091 patients per week), whereas chemotherapy and radiotherapy caseloads (1943-2461 patients per week) remained stable throughout. No changes in institutional or provincial quality-of-care indexes were observed. A total of 3791 surveys (3507 patients and 284 practitioners) were completed; 2207 patients (82%) and 92 practitioners (72%) indicated overall satisfaction with VC. The direct cost of this initiative was CAD$ 202 537, and displacement-related cost savings to patients totaled CAD$ 3 155 946. These findings suggest that implementation of VC at scale at a high-volume cancer center may be feasible. An agile service design approach was able to preserve outpatient caseloads and maintain care quality, while rendering high patient and practitioner satisfaction. These findings may help guide the transformation of telemedicine in the post COVID-19 era. This cohort study of a publicly funded comprehensive cancer center examines the outcomes of a cancer center–wide virtual care program in response to the COVID-19 pandemic.
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影响因子：
3.4
作者：
Kasle, David A.;Torabi, Sina J.;Manes, R. Peter
通讯作者：
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DOI：
10.1016/j.jamcollsurg.2020.04.030
发表时间：
2020-08-01
影响因子：
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作者：
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通讯作者：
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影响因子：
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影响因子：
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作者：
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