Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center
Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center
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DOI：
10.7326/m20-1814
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发表时间：
2020-10-06
影响因子：
39.2
通讯作者：
Artandi, Maja
中科院分区：
文献类型：
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作者：
Srinivasan, Malathi;Asch, Steven;Artandi, Maja
背景：2019 年冠状病毒大流行促使世界各地的卫生系统迅速从亲自就诊转向更安全的视频就诊。目标：在几乎完全过渡到视频就诊 3 周后，寻求利益相关者对视频就诊的可接受性和效果的看法。设计：半结构化定性访谈。地点：位于加州北部 6 个地点的 6 个斯坦福大学普通初级保健和快速护理诊所，有 81 个提供者， 2019 年，共有 123 名工作人员和 97,614 名患者就诊。参与者：53 名项目参与者（重叠角色，如医疗提供者 [n = 20]、医疗助理 [n = 16]、护士 [n = 4]、技术人员 [n = 4] 和管理人员 [n = 13]）接受了有关视频就诊过渡和挑战的采访。干预：在 3 周内，快速护理和初级护理视频就诊率分别从不到 10% 增加到 80% 以上，从 10% 以下增加到 75% 以上。新的视频就诊提供者接受了视频就诊培训和护理质量反馈。创建了新的系统工作流程以适应新的访问方法。 测量：9 名接受过定性研究方法培训的教职员工在 4 天内使用有目的的（管理员和技术人员）和方便的（医疗助理、护士和提供者）抽样进行了 53 名利益相关者访谈。使用快速定性分析方法进行主题分析。结果：分析揭示了 12 个主题，包括流行病作为催化剂；医学之乐；医学安全；从裂缝中溜走；我的角色，重新定义；和新常态。使用 RE-AIM（范围、有效性、采用、实施和维护）框架对主题进行分析，以确定持续计划利用的关键问题。局限性：评估是在部署后立即进行的。尽管观点可能后来发生了变化，但立即评估可以迅速改变计划，并确定需要解决的更广泛的问题，以实现计划的可持续性。结论：在斯坦福大学进行与流行病相关的系统转型后，确定了维持视频访问长期可行性的关键问题。具体来说，技术的易用性必须改进并支持多方视频会议。提供者应该能够照顾他们的患者，无论其地理位置如何。提供者需要通过虚拟检查培训和家庭患者诊断来提供决策支持。最后，持续的视频就诊报销应与患者健康和福祉的价值相称。
Background: The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits.Objective: To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits.Design: Semistructured qualitative interviews.Setting: 6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019.Participants: 53 program participants (overlapping roles as medical providers [n = 20], medical assistants [n = 16], nurses [n = 4], technologists [n = 4], and administrators [n = 13]) were interviewed about video visit transition and challenges. Intervention: In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method.Measurements: 9 faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used.Results: The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization.Limitations: Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability.Conclusion: After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being.