Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic.
Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic.
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DOI：
10.1212/wnl.0000000000010010
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发表时间：
2020-09-01
期刊：
影响因子：
9.9
通讯作者：
Helbig I
中科院分区：
文献类型：
--
作者：
Rametta SC;Fridinger SE;Gonzalez AK;Xian J;Galer PD;Kaufman M;Prelack MS;Sharif U;Fitzgerald MP;Melamed SE;Malcolm MP;Kessler SK;Stephenson DJ;Banwell BL;Abend NS;Helbig I
评估2019冠状病毒病（COVID-19）大流行于2020年3月爆发后，儿童神经科远程医疗门诊护理的快速实施情况。这是一项队列研究，回顾性比较了2019年10月1日至2020年4月24日期间的14，780次面对面接触和2，589次远程医疗接触，包括2，093次音频视频远程医疗和496次预定电话接触。我们比较了面对面和远程医疗的患者人口统计和诊断。对于音频视频远程医疗的遭遇，我们分析了问卷调查的答复，解决供应商的经验，后续计划，技术质量，需要亲自评估，和父母/照顾者的满意度。我们对供应商标记为关注的遭遇进行了手动审查。转换前后患者年龄和主要ICD-10代码无差异。临床医生认为93%（1，286人中的1，200人）的远程医疗令人满意，并建议将远程医疗作为89%（1，286人中的1，144人）的后续护理的组成部分。在40%（1，314人中的519人）的遭遇中报告了技术挑战。在5%（1，285人中的65人）的遭遇后，认为有必要进行面对面评估。86%（217人中的187人）的患者/护理人员表示对远程医疗未来护理感兴趣。与电话就诊相比，少数种族或族裔患者较少参加远程医疗就诊。我们有效地将我们的大部分门诊治疗转化为远程医疗，包括大多数音频视频远程医疗。提供者对绝大多数远程医疗服务的评价是令人满意的，只有一小部分服务需要短期的现场随访。这些研究结果表明，远程医疗是可行的，有效的大部分儿童神经科护理。需要采取更多的战略来确保公平使用远程医疗。
To assess the rapid implementation of child neurology telehealth outpatient care with the onset of the coronavirus disease 2019 (COVID-19) pandemic in March 2020. This was a cohort study with retrospective comparison of 14,780 in-person encounters and 2,589 telehealth encounters, including 2,093 audio-video telemedicine and 496 scheduled telephone encounters, between October 1, 2019 and April 24, 2020. We compared in-person and telehealth encounters for patient demographics and diagnoses. For audio-video telemedicine encounters, we analyzed questionnaire responses addressing provider experience, follow-up plans, technical quality, need for in-person assessment, and parent/caregiver satisfaction. We performed manual reviews of encounters flagged as concerning by providers. There were no differences in patient age and major ICD-10 codes before and after transition. Clinicians considered telemedicine satisfactory in 93% (1,200 of 1,286) of encounters and suggested telemedicine as a component for follow-up care in 89% (1,144 of 1,286) of encounters. Technical challenges were reported in 40% (519 of 1,314) of encounters. In-person assessment was considered warranted after 5% (65 of 1,285) of encounters. Patients/caregivers indicated interest in telemedicine for future care in 86% (187 of 217) of encounters. Participation in telemedicine encounters compared to telephone encounters was less frequent among patients in racial or ethnic minority groups. We effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters. Providers rated the vast majority of telemedicine encounters to be satisfactory, and only a small proportion of encounters required short-term in-person follow-up. These findings suggest that telemedicine is feasible and effective for a large proportion of child neurology care. Additional strategies are needed to ensure equitable telemedicine use.