McConnochie Kenneth M, Conners Gregory P, Brayer Anne F, Goepp Julius, Herendeen Neil E, Wood Nancy E, Thomas Andrew, Ahn Danielle S, Roghmann Klaus J
Department of Pediatrics and Emergency Medicine, Strong Children's Research Center, University of Rochester, Rochester, New York 14642, USA.
Telemed J E Health. 2006 Jun;12(3):308-16. doi: 10.1089/tmj.2006.12.308.
For the purpose of reducing the social and economic burden imposed by common acute childhood illness, we developed a telemedicine model to enable diagnosis and treatment of illness episodes presenting in pediatric office settings. The study objective was to assess the effectiveness of this telemedicine model in replacing illness visits to traditional healthcare settings and to compare effectiveness of this model (base model) with that of alternative models including simple office laboratory tests and albuterol administration (simple model) or a complete complement of tests and procedures (extended model). Eligible subjects had an acute problem and were seen in the pediatric primary care practice or pediatric emergency department of the University of Rochester Medical Center. All subjects were seen by the setting's usual physician. Subjects were also evaluated, based on random assignment, by a study physician in person or by a study physician via telemedicine. Effectiveness was defined as completion of the visit to the point that diagnosis was made. Forms completed by study physicians, and standard medical records indicating the tests and procedures requested for the purpose of completing the visit, were used to identify the model used in completing the visit. Effectiveness (proportion of visits completed) of the base model was assessed and its effectiveness was compared to that of simple and extended telemedicine models. Among 520 randomized visits, 492 were evaluated by study physicians in person (253) or via telemedicine (239). Using the base model, study physicians completed 74.1% of visits via telemedicine compared to 76.7% for study physicians in person and 76.0% for usual physicians. The simple model increased completion rates substantially. Using this model, study physicians completed 84.9% of visits via telemedicine compared to 86.6% for study physicians in person and 85.2% for usual physicians. The extended model increased effectiveness in completing visits still more, with telemedicine study physicians completing 97.1% of visits compared to 96.8% for in-person study physicians and 100% for usual physicians. Approximately 85% of illness visits presenting to primary care pediatric practice could be completed using a telemedicine model that included only simple office laboratory testing and albuterol administration.
为了减轻常见儿童急性疾病带来的社会和经济负担，我们开发了一种远程医疗模式，以实现对儿科门诊中出现的疾病发作进行诊断和治疗。该研究的目的是评估这种远程医疗模式在替代前往传统医疗机构就诊方面的有效性，并将该模式（基础模式）与包括简单门诊实验室检查和沙丁胺醇给药（简单模式）或全套检查和程序（扩展模式）在内的替代模式的有效性进行比较。符合条件的受试者患有急性疾病，并在罗切斯特大学医学中心的儿科初级保健诊所或儿科急诊科就诊。所有受试者均由该机构的常规医生诊治。受试者还根据随机分配，由研究医生亲自评估或由研究医生通过远程医疗进行评估。有效性定义为完成就诊直至做出诊断。研究医生填写的表格以及表明为完成就诊而要求进行的检查和程序的标准医疗记录，用于确定完成就诊所使用的模式。评估了基础模式的有效性（就诊完成比例），并将其有效性与简单和扩展远程医疗模式的有效性进行比较。在520次随机就诊中，492次由研究医生亲自评估（253次）或通过远程医疗评估（239次）。使用基础模式时，研究医生通过远程医疗完成了74.1%的就诊，而亲自就诊的研究医生完成率为76.7%，常规医生完成率为76.0%。简单模式大幅提高了完成率。使用该模式时，研究医生通过远程医疗完成了84.9%的就诊，亲自就诊的研究医生完成率为86.6%，常规医生完成率为85.2%。扩展模式在完成就诊方面的有效性进一步提高，远程医疗研究医生完成了97.1%的就诊，亲自就诊的研究医生完成率为96.8%，常规医生完成率为100%。约85%出现在儿科初级保健诊所的疾病就诊可以使用仅包括简单门诊实验室检查和沙丁胺醇给药的远程医疗模式完成。
