Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework.
Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework.
复制标题
DOI：
10.2196/23775
复制
发表时间：
2021-01-26
影响因子：
7.4
通讯作者：
Shaw SE
中科院分区：
文献类型：
--
作者：
James HM;Papoutsi C;Wherton J;Greenhalgh T;Shaw SE
COVID-19将视频咨询推到了聚光灯下，因为全世界的医疗保健从业者都转向远程提供护理。有证据表明，视频咨询是可接受的，安全的，在选定的条件和设置有效。然而，迄今为止的研究主要集中在最初的采用上，很少考虑如何将视频咨询纳入主流并持续下去。本研究试图做到以下几点：（1）审查和综合报告的机会，挑战和经验教训，在扩大，传播和视频磋商的可持续性，（2）确定可转移的见解，可以告知政策和实践。我们通过PubMed、CINAHL和Web of Science中的系统检索确定了论文。纳入了报告同步视频磋商的文章，这些磋商在最初的试点或可行性阶段之后扩展到一个以上的环境，自2010年以来发表。我们使用不采用、放弃和对扩展、传播和可持续性（NASSS）框架的挑战来综合与7个领域相关的研究结果：了解使用视频咨询的健康状况、技术平台和相关外围设备的材料属性、患者和开发人员的价值主张、采用者系统的作用、组织因素，更广泛的宏观层面的考虑，以及随着时间的推移而出现。我们确定了13篇论文，描述了6个地区的10种不同的视频咨询服务，涵盖以下内容：（1）视频到户服务，将提供者直接连接到患者;（2）中心辐射模型，将中心枢纽的提供者连接到农村中心的患者;（3）大规模自上而下的评估在国家卫生管理部门扩大或传播。服务范围包括康复、老年病、癌症手术、糖尿病和精神健康，以及一般专科护理和初级护理。推广和扩大的潜在推动因素包括嵌入式领导和远程保健倡导者的存在、适当的报销机制、方便用户的技术、预先存在的工作人员关系以及随着时间的推移进行调整（技术和服务）。挑战往往与服务发展有关，如缺乏长期战略计划、抵制变革、费用和偿还问题以及工作人员的技术经验。对扩大和推广视频协商所面临的挑战的阐述有限。这与缺乏理论化相结合，论文倾向于将传播和扩展视为多种技术实现的总和，而不是将实现广泛采用所需的不同过程理论化。目前仍然严重缺乏证据来支持视频咨询的推广和扩大。鉴于COVID-19导致的近期变化速度，迫切需要更明确的证据基础来支持全球努力并匹配扩展使用的热情。
COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use.
登录
查看更多内容
影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
3.8
作者：
Interian, Alejandro;King, Arlene R.;Damschroder, Laura J.
通讯作者：
Damschroder, Laura J.
影响因子：
4.7
作者：
Crotty, Maria;Killington, Maggie;Carati, Colin
通讯作者：
Carati, Colin
影响因子：
4.7
作者：
Darkins, Adam
通讯作者：
Darkins, Adam