Postdischarge Virtual Visits for Low-risk Surgeries A Randomized Noninferiority Clinical Trial
Postdischarge Virtual Visits for Low-risk Surgeries A Randomized Noninferiority Clinical Trial
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DOI：
10.1001/jamasurg.2020.6265
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发表时间：
2021-01-13
期刊：
影响因子：
16.9
通讯作者：
Reinke, Caroline E.
中科院分区：
文献类型：
--
作者：
Harkey, Kristen;Kaiser, Nicole;Reinke, Caroline E.
重要性出院后基于视频的虚拟访问是外科护理的一个日益增长的方面，并在冠状病毒疾病的背景下急剧增加2019（COVID-19）pandemic.Objective To evaluate the outcome of all-cause 30-day hospital encounterment proportion among patients who have a postdischarge post-based video-based virtual visit following with in-person following.Design，SETTING，AND PARTICIPANTS在城市环境中进行的对照非劣效性试验，包括来自小型社区医院和大型三级医院的患者。纳入了在这2家医院接受微创阑尾切除术或胆囊切除术的患者，这些患者由一组外科医生负责急诊普外科。接受择期和非择期手术的患者包括included.INTERVENTIONS患者随机以2：1的方式，以视频为基础的虚拟访问或在人visit.Main结局和measurements的主要结果是30天的医院遇到的患者的百分比，我们假设不会有一个显着增加30天的医院遇到的比例为患者谁接受基于视频的虚拟出院后护理的患者相比，谁接受标准（在人）护理。医院遭遇包括急诊科访问，观察，或住院admission.Results筛选了1645例患者，289例患者被随机分配到虚拟组和143人在人组。53名患者交叉进入亲自随访组。在虚拟访视中，医院就诊的患者百分比具有非劣效性（12.8% vs 13.3%，面对面访视，Delta 0.5%，单侧95% CI，-无穷大至5.2%）。患者与临床医生在一起的时间（平均8.4分钟虚拟vs 7.8分钟面对面; P = .30）没有差异，但总体术后访视时间的中位数缩短了27.5分钟（95%可信区间，-33.5 to -24.0）.结论和相关性基于虚拟访问并没有增加医院就诊的比例，并提供了更短的总时间承诺，但与手术团队成员的时间相等。这些信息将帮助外科医生和患者对使用基于视频的虚拟访问更有信心。
IMPORTANCE Postdischarge video-based virtual visits are a growing aspect of surgical care and have dramatically increased in the setting of the coronavirus disease 2019 (COVID-19) pandemic.OBJECTIVE To evaluate the outcomes of all-cause 30-day hospital encounter proportion among patients who have a postdischarge video-based virtual visit follow-up compared with in-person follow-up.DESIGN, SETTING, AND PARTICIPANTS Randomized, active, controlled noninferiority trial in an urban setting, including patients from a small community hospital and a large, tertiary care hospital. Patients who underwent minimally invasive appendectomy or cholecystectomy by a group of surgeons who cover emergency general surgery at these 2 hospitals were included. Patients undergoing elective and nonelective procedures were included.INTERVENTIONS Patients were randomized in a 2:1 fashion to video-based virtual visit or in-person visit.MAIN OUTCOMES AND MEASURES The primary outcome is the percentage of patients with 30-day hospital encounter, and we hypothesized that there would not be a significant increase in the 30-day hospital encounter proportion for patients who receive video-based virtual postdischarge care compared with patients who receive standard (in-person) care. Hospital encounter includes emergency department visit, observation, or inpatient admission.RESULTS A total of 1645 patients were screened; 289 patients were randomized to the virtual group and 143 to the in-person group. Fifty-three patients crossed over to the in-person follow-up group. The percentage of patients who had a hospital encounter was noninferior for virtual visits (12.8% vs 13.3% for in-person, Delta 0.5% with 1-sided 95% CI, -infinity to 5.2%). The amount of time patients spent with the clinician (mean of 8.4 minutes virtual vs 7.8 minutes in-person; P = .30) was not different, but the median overall postoperative visit time was 27.5 minutes shorter (95% CI, -33.5 to -24.0).CONCLUSIONS AND RELEVANCE Postdischarge video-based virtual visits did not increase hospital encounter proportions and provided shorter overall time commitment but equal time with the surgical team member. This information will help surgeons and patients feel more confident in using video-based virtual visits.