Patient choice of telemedicine encounters

总结 本研究提案是对AHRQ（NOT-HS-16-009）的回应，并检查了质量和安全性 实时患者-提供者视频和电话访问的影响，交互式卫生信息技术 (IT)有潜力通过方便的医疗保健访问吸引患者的工具。远程医疗可以提供 患者可以选择访问提供者访问，而没有安全运输，安排 从工作或护理中休假，或在候诊室度过时间。即使美国病人 越来越多地从第三方服务机构购买基于互联网的远程医疗就诊，而不需要亲临现场， 关于患者采用远程医疗进行初级保健的科学证据仍然存在差距 （与亲自访问相比）。这项研究将检查2016年的健康IT实施，为患者提供- 通过综合医疗保健的患者门户发起初级保健远程医疗 输送系统。所有通过门户安排与初级保健提供者预约的患者 （网站和移动的应用程序）直接在传统的亲自访问和远程医疗之间进行选择 通过视频或电话访问。在为期五年的研究期间（2016 - 2020），我们将研究一个大型的 患者预定远程医疗预约的样本，包括超过50，000次视频访问和500，000次 电话访问，相比之下，数以百万计的病人安排在人的访问。使用患者调查 （N= 1，500）和利益相关者的关键线人访谈，我们将研究远程医疗用户的经验 和决策者，包括技术可用性、便利性和患者报告的结局。研究中 在这种情况下，这种新型的患者远程医疗接入与患者自己现有的医疗保健完全集成 提供商和全面的电子健康记录（EHR）。我们将检查患者的临床问题， 与选择远程医疗就诊相比较， (Aim 1），以及通过指南推荐的医疗保健进行远程医疗的质量和安全性 过程（处方和订购）、随访访视和事件（急诊科访视）（目标2）。我们 将测试的假设，护理过程和短期事件率为病人发起的远程医疗 接触不会比患者发起的面对面访视更差（非劣效性假设），而 考虑到患者参与度、健康状况的最新变化、病例组合、亲自就诊的费用分摊， 互联网接入和患者人口统计学和社会经济特征。通过检查早期采用者 的技术，以及大量和多样化的患者群体，该项目有可能提供及时的 为新兴的远程医疗政策、技术采用决策和患者在真实的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.