Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits.
Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits.
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DOI：
10.1001/jamainternmed.2015.8248
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发表时间：
2016-05-01
影响因子：
39
通讯作者：
Dudley RA
中科院分区：
文献类型：
--
作者：
Schoenfeld AJ;Davies JM;Marafino BJ;Dean M;DeJong C;Bardach NS;Kazi DS;Boscardin WJ;Lin GA;Duseja R;Mei YJ;Mehrotra A;Dudley RA
商业虚拟就诊是治疗常见急性疾病的一种日益流行的护理模式。在商业虚拟就诊中，患者访问一个网站，通过视频会议、电话或网络聊天与他们之前没有关系的医生同步连接。目前还没有评估通过这些网站提供的护理是否相似，或者这些网站之间的质量是否存在差异。评估虚拟就诊公司之间护理质量的差异。我们使用经过培训的标准化患者进行了一项审核研究。标准化患者向商业虚拟就诊公司介绍了六种常见的急性疾病（脚踝疼痛、链球菌性咽炎、病毒性咽炎、急性鼻窦炎、腰痛和复发性尿路感染）。网络流量最高的八个商业虚拟访问网站。主要结果是病史和体格检查的完整性、给出正确的诊断（相对于错误的诊断或未给出任何诊断）以及遵守关键管理决策指南。从 2013 年 5 月到 2014 年 7 月，标准化患者完成了 599 次商业虚拟就诊。虚拟就诊的病史和体检完成率为 69.6%（95% 置信区间 [CI]，67.7%-71.6%），诊断正确命名为 76.5%（CI，72.9%-79.9%），关键管理决策遵循指南为 54.3%（CI， 50.2%-58.3%）。八个网站的遵循指南护理率从 34.4% 到 66.1% 不等。病毒性咽炎和急性鼻窦炎（12.8-82.1%）的网站差异显着大于链球菌性咽炎和腰痛（74.6-96.5%）或踝关节疼痛和复发性尿路感染（3.4-40.4%）。不同沟通方式（视频、电话、网络聊天）的指南遵守情况没有统计学上的显着差异。我们发现，为管理常见急性疾病提供虚拟就诊的公司之间的质量存在显着差异。某些条件下的性能差异比其他条件下的差异更大，但沟通模式没有差异。
Commercial virtual visits are an increasingly popular model of care for the management of common, acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously—via videoconference, telephone, or webchat—to a physician with whom they have no prior relationship. There has been no assessment of whether the care delivered through those websites is similar, or whether quality varies among the sites. To assess the variation in quality of care among virtual visit companies. We performed an audit study using trained standardized patients. The standardized patients presented to commercial virtual visit companies with six common, acute illnesses (ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent urinary tract infection). The eight commercial virtual visit websites with the highest web traffic. The primary outcomes were completeness of histories and physical examinations, naming the correct diagnosis (versus an incorrect diagnosis or not naming any diagnosis), and adherence to guidelines of key management decisions. Standardized patients completed 599 commercial virtual visits from May 2013 to July 2014. Histories and physical examinations were complete in 69.6% (95% confidence interval [CI], 67.7%-71.6%) of virtual visits, diagnoses were correctly named in 76.5% (CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 54.3% (CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 34.4% to 66.1% across the eight websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (12.8-82.1%) than for streptococcal pharyngitis and low back pain (74.6-96.5%) or ankle pain and recurrent urinary tract infection (3.4-40.4%). There was no statistically significant variation in guideline adherence by mode of communication (video vs. telephone vs. webchat). We found significant variation in quality among companies providing virtual visits for management of common acute illnesses. There was more variation in performance for some conditions than for others, but there was no variation by mode of communication.
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影响因子：
11.8
作者：
Gupta, Kalpana;Hooton, Thomas M.;Soper, David E.
通讯作者：
Soper, David E.
影响因子：
2.2
作者：
Dekker, Anne R. J.;Verheij, Theo J. M.;van der Velden, Alike W.
通讯作者：
van der Velden, Alike W.
影响因子：
39.2
作者：
Snow, V;Mottur-Pilson, C;Hoffman, LR
通讯作者：
Hoffman, LR
影响因子：
9.7
作者：
Uscher-Pines, Lori;Mehrotra, Ateev
通讯作者：
Mehrotra, Ateev
影响因子：
120.7
作者：
McIsaac, WJ;Kellner, JD;Low, DE
通讯作者：
Low, DE