Implementation of Direct-to-Patient Mobile Teledermatology in VA.
Implementation of Direct-to-Patient Mobile Teledermatology in VA.
复制标题
在弗吉尼亚州实施直接面向患者的移动远程皮肤科。
DOI：
10.1007/s11606-023-08480-1
复制
发表时间：
2024
影响因子：
5.7
通讯作者：
Oh,DennisH
中科院分区：
文献类型：
--
作者：
Peracca,SaraB;Lachica,Olevie;Lamkin,RebeccaP;Jackson,GeorgeL;Mohr,DavidC;King,HeatherA;Whited,JohnD;Fonseca,AlleneS;Morris,IsisJ;Gifford,AllenL;Weinstock,MartinA;Oh,DennisH
背景创新技术可以改善患者获得医疗保健的机会，但必须成功实施才能有效。目标我们评估了退伍军人事务部(VA)对My VA Images的实施，My VA Images是一款直接面向患者的异步远程皮肤病移动应用程序，使已建立的皮肤病患者能够远程接受跟踪护理，而不是面对面。设计/参与者/方法在3个设施进行试点测试后，每3个月将该应用程序引入28个设施(4组，每组7个)，使用阶梯楔形群组随机设计。使用组织实施有效性理论，我们使用定性和定量数据检查了应用程序的实施，这些数据包括来自退伍军人管理局企业数据仓库的遭遇数据；来自退伍军人管理局移动健康数据库的应用程序使用率；设施代表的双月报告；对临床医生的电话采访；以及运营合作伙伴和设施员工之间的书面交流。关键结果实施政策和实践包括退伍军人管理局扩大家庭远程医疗的愿景和营销/沟通战略。新冠肺炎大流行通过强调人员配备、引入相互竞争的需求以及影响利益相关者对该应用的态度，包括其与他们价值观的契合度，主导了该应用的实施环境。这些因素与混合执行效果有关，被定义为高质量的一致使用。在31家暴露的设施中，有19家准备使用这款应用程序；10家机构将其用于实际的患者护理，7家机构按照最初的计划使用。住院医生、执业护士和医生助理比主治医生更有可能使用这款应用。大流行前暴露于APP的机构更有可能使用和维持新流程。结论尽管退伍军人管理局有共同的使命、集成的医疗系统和利益相关者的广泛兴趣，但在实施移动远程皮肤病方面存在可考虑的异质性。找出机会瞄准有利的设施和用户群体(分别是教学设施和医生延伸器)，同时解决内部实施障碍，包括与电子健康记录的不完全整合以及人员配备不足，可能有助于优化直接到患者的远程医疗的初始影响。冠状病毒大流行是一个明显的外在障碍。临床试验注册NCT03241589
BackgroundInnovative technology can enhance patient access to healthcare but must be successfully implemented to be effective.ObjectiveWe evaluated Department of Veterans Affairs’ (VA’s) implementation ofMy VA Images, a direct-to-patient asynchronous teledermatology mobile application enabling established dermatology patients to receive follow-up care remotely instead of in-person.Design /Participants/ApproachFollowing pilot testing at 3 facilities, the app was introduced to 28 facilities (4 groups of 7) every 3 months using a stepped-wedge cluster-randomized design. Using the Organizational Theory of Implementation Effectiveness, we examined the app’s implementation using qualitative and quantitative data consisting of encounter data from VA’s corporate data warehouse; app usage from VA’s Mobile Health database; bi-monthly reports from facility representatives; phone interviews with clinicians; and documented communications between the operational partner and facility staff.Key ResultsImplementation policies and practices included VA’s vision to expand home telehealth and marketing/communication strategies. The COVID-19 pandemic dominated the implementation climate by stressing staffing, introducing competing demands, and influencing stakeholder attitudes to the app, including its fit to their values. These factors were associated with mixed implementation effectiveness, defined as high quality consistent use. Nineteen of 31 exposed facilities prepared to use the app; 10 facilities used it for actual patient care, 7 as originally intended. Residents, nurse practitioners, and physician assistants were more likely than attendings to use the app. Facilities exposed to the app pre-pandemic were more likely to use and sustain the new process.ConclusionsConsiderable heterogeneity existed in implementing mobile teledermatology, despite VA’s common mission, integrated healthcare system, and stakeholders’ broad interest. Identifying opportunities to target favorable facilities and user groups (such as teaching facilities and physician extenders, respectively) while addressing internal implementation barriers including incomplete integration with the electronic health record as well as inadequate staffing may help optimize the initial impact of direct-to-patient telehealth. The COVID pandemic was a notable extrinsic barrier.Clinical Trials RegistrationNCT03241589