Marshall Christy L, Petersen Nancy J, Naik Aanand D, Vander Velde Nancy, Artinyan Avo, Albo Daniel, Berger David H, Anaya Daniel A
1 Michael E. DeBakey Department of Surgery, Baylor College of Medicine , Houston, Texas.
Telemed J E Health. 2014 Aug;20(8):705-11. doi: 10.1089/tmj.2013.0320. Epub 2014 May 20.
Tumor board (TB) conferences facilitate multidisciplinary cancer care and are associated with overall improved outcomes. Because of shortages of the oncology workforce and limited access to TB conferences, multidisciplinary care is not available at every institution. This pilot study assessed the feasibility and acceptance of using telemedicine to implement a virtual TB (VTB) program within a regional healthcare network.
The VTB program was implemented through videoconference technology and electronic medical records between the Houston (TX) Veterans Affairs Medical Center (VAMC) (referral center) and the New Orleans (LA) VAMC (referring center). Feasibility was assessed as the proportion of completed VTB encounters, rate of technological failures/mishaps, and presentation duration. Validated surveys for confidence and satisfaction were administered to 36 TB participants to assess acceptance (1-5 point Likert scale). Secondary outcomes included preliminary data on VTB utilization and its effectiveness in providing access to quality cancer care within the region.
Ninety TB case presentations occurred during the study period, of which 14 (15%) were VTB cases. Although one VTB encounter had a technical mishap during presentation, all scheduled encounters were completed (100% completion rate). Case presentations took longer for VTB than for regular TB cases (p=0.0004). However, VTB was highly accepted with mean scores for satisfaction and confidence of 4.6. Utilization rate of VTB was 75%, and its effectiveness was equivalent to that observed for non-VTB cases.
Implementation of VTB is feasible and highly accepted by its participants. Future studies should focus on widespread implementation and validating the effectiveness of this model.
肿瘤病例讨论会(TB)有助于多学科癌症护理,并与整体预后改善相关。由于肿瘤学劳动力短缺以及参加TB会议的机会有限,并非每个机构都能提供多学科护理。这项试点研究评估了使用远程医疗在区域医疗网络内实施虚拟TB(VTB)计划的可行性和可接受性。
VTB计划通过视频会议技术和电子病历在休斯顿(德克萨斯州)退伍军人事务医疗中心(VAMC)(转诊中心)和新奥尔良(路易斯安那州)VAMC(转诊中心)之间实施。可行性评估指标包括完成的VTB会诊比例、技术故障/事故发生率和报告时长。对36名TB参与者进行了关于信心和满意度的有效调查,以评估接受程度(1 - 5点李克特量表)。次要结果包括关于VTB利用率及其在该地区提供优质癌症护理可及性方面有效性的初步数据。
在研究期间共进行了90次TB病例报告,其中14次(15%)为VTB病例。尽管有一次VTB会诊在报告过程中出现技术问题,但所有预定的会诊都完成了(完成率100%)。VTB病例报告比常规TB病例花费的时间更长(p = 0.0004)。然而,VTB的接受度很高,满意度和信心的平均得分均为4.6。VTB的利用率为75%,其有效性与非VTB病例相当。
VTB的实施是可行的,并且其参与者对其接受度很高。未来的研究应侧重于广泛实施并验证该模式的有效性。