Callahan Charles W, Malone Francis, Estroff David, Person Donald A
Department of Pediatrics, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA.
Arch Pediatr Adolesc Med. 2005 Apr;159(4):389-93. doi: 10.1001/archpedi.159.4.389.
Pediatric subspecialists are often separated from the children who need them by distance, time, or socioeconomic factors. The Electronic Children's Hospital of the Pacific is an Internet-based store-and-forward pediatric consultation system established to overcome these barriers.
To characterize the use of the Electronic Children's Hospital of the Pacific and its impact on access to specialty care, the quality of the care provided, and cost savings.
Prospective trial.
Twenty-two military treatment facilities in the Pacific.
Primary care providers, pediatric consultants, and 5 reviewers.
Consult response time, physician panel review, and evacuation cost avoidance.
There were 267 cases from 16 sites. The mean +/- SD response time by a consultant was 32 +/- 8 hours. The panel review deemed that the initial diagnosis was changed or modified in 15% (39/267) of the cases, the diagnostic plan was changed or modified in 21% (57/267), and the treatment plan was changed or modified in 24% (64/267) (P < .01 for all). Routine air evacuations to a tertiary care medical center were avoided in 32 cases (12%), with an estimated cost savings of $185 408.
The Electronic Children's Hospital of the Pacific improved the quality of patient care by providing expeditious specialty consultation. Significant cost avoidance in this military pediatric population was documented. Store-and-forward Internet-based teleconsultation is an effective means of providing pediatric subspecialty consultation to a population of underserved children.
儿科专科医生常常因距离、时间或社会经济因素而无法为有需求的儿童提供服务。太平洋电子儿童医院是一个基于互联网的存储转发式儿科会诊系统，旨在克服这些障碍。
描述太平洋电子儿童医院的使用情况及其对专科护理可及性、所提供护理质量和成本节约的影响。
前瞻性试验。
太平洋地区的22个军事治疗机构。
初级保健提供者、儿科顾问和5名评审员。
会诊响应时间、医生小组评审以及避免后送成本。
来自16个地点的267例病例。顾问的平均±标准差响应时间为32±8小时。小组评审认为，15%（39/267）的病例初始诊断被改变或修正，21%（57/267）的病例诊断计划被改变或修正，24%（64/267）的病例治疗计划被改变或修正（所有P<0.01）。32例（12%）避免了常规空运至三级医疗中心，估计节省成本185408美元。
太平洋电子儿童医院通过提供快速的专科会诊提高了患者护理质量。在这一军事儿科人群中记录到显著的成本节约。基于互联网的存储转发式远程会诊是为服务不足的儿童群体提供儿科专科会诊的有效手段。
