Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study.
Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study.
复制标题
DOI：
10.2196/33981
复制
发表时间：
2022-06-20
影响因子：
7.4
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Zachrison, Kori S.;Hayden, Emily M.;Boggs, Krislyn M.;Boyle, Tehnaz P.;Gao, Jingya;Samuels-Kalow, Margaret E.;Marcin, James P.;Camargo, Carlos A., Jr.
远程医疗用于紧急卒中护理(远程卒中)已被广泛采用，使许多医院能够获得卒中中心认证。远程保健在儿科急救中的应用还不是很广泛。我们的主要目标是确定政策或认证要求的差异是否有助于远程中风与儿童远程保健的不同吸收。我们假设，基于患者数量、院前路径政策和认证要求的不同，财务激励的差异导致急诊科(ED)采用远程中风与儿科远程医疗的不同。我们使用2016年美国国家急诊部清单来确定使用远程中风和儿科远程医疗服务的急诊室。我们调查了所有使用儿科远程医疗服务的急诊室(n=339)和1758个使用远程卒中服务的急诊室(n=366)的便利样本。这些调查的特点是ED的人员配置、调动模式、采用的原因和使用频率。我们使用双变量比较来检验仅有远程卒中服务、仅有儿科远程医疗服务或两者兼有的急救服务采用和使用原因的差异。在接受调查的442名急诊科医生中，378人(85.5%)表示使用远程中风或儿童远程保健，或两者兼而有之。这两种服务的急诊室在床位大小、容量和急诊室就诊覆盖率上都比仅有远程卒中服务或仅有儿科远程保健服务的患者小。总的来说，接受远程卒中服务的急诊室报告的使用频率高于接受儿科远程医疗服务的急诊室：14.1%(45/320)接受远程卒中服务的急诊室每周使用，而接受儿科远程保健服务的急诊室每周使用率为2.9%(8/272)(P<；.001)。此外，在接受儿科远程医疗服务的272名急诊室中，37名(13.6%)报告在过去一年中没有就诊。在各种应用中，最常被选择采用的理由是“提高临床护理水平”。与政策相关的原因(即遵守外部认证或标准或改善ED在质量指标上的表现)很少被认为是最重要的，但这些原因在远程中风采用(12/320，3.8%)略高于儿科远程保健采用(1/272，0.4%；P=.003)。2016年，更多的美国急诊科医生获得了远程中风服务，而不是儿科远程医疗服务；在使用该技术的急诊科医生中，为中风患者提供咨询的频率高于为儿科患者提供咨询的频率。在所有急救药物中，采用的最常见的原因是与临床护理有关。
Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth. We used the 2016 National Emergency Department Inventory–USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both. Of the 442 EDs surveyed, 378 (85.5%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1% (45/320) of EDs with telestroke services reported weekly use versus 2.9% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was “improving level of clinical care.” Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8%) than for pediatric telehealth adoption (1/272, 0.4%; P=.003). In 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care.
登录
查看更多内容
影响因子：
1.4
作者：
Ball, Jane W.;Sanddal, Nels D.;Meredith, Wayne
通讯作者：
Meredith, Wayne
影响因子：
9.7
作者：
Purnell, Tanjala S.;Calhoun, Elizabeth A.;Cooper, Lisa A.
通讯作者：
Cooper, Lisa A.
影响因子：
2.2
作者：
Cicero, Mark X.;Walsh, Barbara;Cone, David C.
通讯作者：
Cone, David C.
影响因子：
3.2
作者：
Sullivan, Ashley F.;Rudders, Susan A.;Camargo, Carlos A., Jr.
通讯作者：
Camargo, Carlos A., Jr.
DOI：
10.1093/jamia/ocaa048
发表时间：
2020-06-01
影响因子：
6.4
作者：
Turer, Robert W.;Jones, Ian;Ward, Michael J.
通讯作者：
Ward, Michael J.