Patient choice of telemedicine encounters

摘要 本研究建议响应AHRQ(NOT-HS-16-009)，并检查质量和安全 实时患者-提供者视频和电话访问、交互式医疗信息技术的影响 (IT)有潜力通过方便的医疗保健途径让患者参与进来的工具。远程医疗可以提供 患者可以选择无障碍地访问医疗服务提供者，确保交通、安排 从工作或照顾中抽出时间，或在候车室里度过时间。即使是美国的病人 越来越多地从没有面对面设施的第三方服务购买基于互联网的远程医疗访问， 关于患者在初级保健中采用远程医疗的科学证据中仍然存在空白 (与面对面访问相比)。这项研究将检查2016年的医疗IT实施情况，为患者提供- 通过集成医疗保健的患者门户发起初级保健远程医疗 传送系统。所有患者通过门户与初级保健提供者预约 (网站和移动应用)直接在传统的面对面访问和远程医疗之间进行选择 访问，无论是通过视频还是电话。在五年的研究期内(2016-2020)，我们将审查一个大型 患者安排的远程医疗预约样本，包括50,000多次视频访问和500,000次 电话就诊，相比之下，数百万患者计划面对面就诊。使用患者调查 (n=1,500)和利益相关者关键线人访谈，我们将检查远程医疗用户的体验 以及决策者，包括技术可用性、便利性和患者报告的结果。在研究中 这种新的患者远程医疗通道与患者自己现有的医疗保健完全结合在一起 供应商和全面电子健康记录(EHR)。我们将检查患者的临床关切，并 与面对面会诊相比，与选择远程医疗会诊相关的访问措施 (目标1)，以及通过指南建议的保健服务实现的远程医疗的质量和安全 流程(处方和订购)、后续访问和事件(急诊科访问)(目标2)。我们 将测试患者发起的远程医疗的护理过程和短期事件发生率的假设 相遇不会比患者发起的面对面访问更糟糕(非自卑假设)，而 考虑到患者的参与度、健康状况的最新变化、病例组合、面对面就诊的费用分摊、 互联网接入，以及患者的人口统计和社会经济特征。通过检查早期采用者 技术，以及大量和多样化的患者群体，这个项目有潜力提供及时的 为新兴的远程医疗政策、技术采用决策和患者在现实世界中的使用提供信息的证据 和临床医生。

SUMMARY This research proposal is in response to AHRQ (NOT-HS-16-009) and examines the quality and safety impacts of real-time patient-provider video and telephone visits, interactive health information technology (IT) tools with potential to engage patients through convenient health care access. Telemedicine can offer patients the choice to access a provider visit without the obstacles of securing transportation, arranging time-off from work or care-giving, or spending time in a waiting-room. Even as American patients are increasingly purchasing internet-based telemedicine visits from third party services without in-person facilities, gaps remain in the scientific evidence about patient adoption of telemedicine for primary care encounters (compared with in-person visits). This study will examine a 2016 health IT implementation offering patient - initiated primary care telemedicine encounters through the patient portal of an integrated healthcare delivery system. All patients scheduling an appointment with a primary care provider through the portal (website and mobile application) choose directly between a traditional in -person visit and a telemedicine visit, either by video or telephone. Over a five year study period (2016 -2020), we will examine a large sample of patient-scheduled telemedicine appointments, including over 50,000 video visits and 500,000 telephone visits, compared with millions of patient-scheduled in-person visits. Using patient surveys (N=1,500) and stakeholder key informant interviews, we will examine the experiences of telemedicine users and decision-makers, including technology usability, convenience, and patient-reported outcomes. In the study setting, this novel patient telemedicine access is fully integrate d with patients’ own existing health care providers and comprehensive electronic health record (EHR). We will examine patient clinical concerns and access measures associated with the choice of a telemedicine encounter compared with in-person encounters (Aim 1), and the quality and safety of the telemedicine encounters through guideline-recommended health care processes (prescribing and ordering), follow-up visits, and events ( emergency department visits) (Aim 2). We will test the hypotheses that care processes and short-term event rates for patient-initiated telemedicine encounters will not be worse than for patient-initiated in-person visits (non-inferiority hypothesis), while accounting for patient engagement, recent changes in health status, case-mix, cost-sharing for in-person visits, internet access, and patient demographic and socio-economic characteristics. By examining an early adopter of the technologies, and a large and diverse patient population, this project has the potential to provide timely evidence to inform emerging telehealth policies, technology adoption decisions, and real world use by patients and clinicians.