Telemedicine for Pediatric Urological Postoperative Care is Safe, Convenient and Economical
Telemedicine for Pediatric Urological Postoperative Care is Safe, Convenient and Economical
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DOI：
10.1097/ju.0000000000000750
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发表时间：
2020-07-01
影响因子：
6.6
通讯作者：
Estrada, Carlos R., Jr.
中科院分区：
文献类型：
--
作者：
Finkelstein, Julia B.;Cahill, Dylan;Estrada, Carlos R., Jr.
目的：我们比较了虚拟就诊，即远程患者就诊，通过一个实时视频系统，与传统的面对面就诊在临床结果，家庭经验和成本方面的儿童泌尿外科手术人群。材料和方法：患者参加了一项前瞻性队列研究，比较了2018年4个月期间的术后虚拟和面对面访问。跟踪约会状态和时间指标。主要结果是虚拟就诊的安全性，通过比较额外的亲自就诊次数、急诊就诊次数和医院再入院次数来评估。次要结果包括家庭对遭遇和相关费用的评估。每次访问后，家庭被要求完成一项调查，评估错过的工作/学校和直接成本。机会成本是根据报告的缺勤时间、全国平均小时工资和访问时间估算的。结果：共完成107次虚拟和100次面对面的术后访问。患者特征、预约依从性或临床结果在队列之间没有差异。旅行和等待护理占亲自就诊总时间的98.4%。通过虚拟访问，家长和孩子的旷工和旷课时间分别显著减少。与面对面就诊相关的机会成本计算为每分钟23.75美元，而虚拟就诊为1.14美元。结论：对于儿科术后护理，虚拟就诊与更短的等待时间、减少旷工和旷课有关，临床结果与亲自就诊相似。远程医疗似乎降低了与这些短暂但重要的会面相关的费用。
Purpose: We compared virtual visits, ie remote patient encounters, via a live video system, with conventional in-person visits with respect to clinical outcomes, family experience and costs in a pediatric urology surgical population.Materials and Methods: Patients were enrolled in a prospective cohort study comparing postoperative virtual and in-person visits during a 4-month period in 2018. Appointment status and time metrics were tracked. The primary outcome was the safety of virtual visits, assessed by comparing the number of additional in-person visits, emergency department encounters and hospital readmissions. Secondary outcomes included the family assessment of the encounter and associated costs. After each visit families were prompted to complete a survey that assessed missed work/school and direct costs. Opportunity cost was estimated using reported missed work time, average national hourly wage and visit duration.Results: Overall 107 virtual and 100 in-person postoperative visits were completed. There was no difference in patient characteristics, appointment compliance or clinical outcomes between the cohorts. Travel and waiting for care accounted for 98.4% of the total time spent for an in-person visit. With the virtual visit significantly less work and school were missed by parents and children, respectively. The opportunity costs associated with an in-person visit were computed at $23.75 per minute of face time with a physician, compared to $1.14 for a virtual visit.Conclusions: For pediatric postoperative care virtual visits are associated with shorter wait times, decreased missed work and school, and clinical outcomes similar to those of in-person visits. Telemedicine appears to reduce the costs associated with these brief but important encounters.