Uscher-Pines Lori, Kahn Jeremy M
1 RAND Corporation , Arlington, Virginia.
Telemed J E Health. 2014 Nov;20(11):990-6. doi: 10.1089/tmj.2014.0015. Epub 2014 Sep 19.
Pediatric emergency telemedicine has the potential to improve the quality of pediatric emergency care in underserved areas, reducing socioeconomic disparities in access to care. Yet, telemedicine in the pediatric emergency setting remains underutilized. We aimed to assess the current state of pediatric emergency telemedicine and identify unique success factors and barriers to widespread use.
We conducted a telephone survey of current, former, and planned pediatric emergency telemedicine programs in the United States.
We surveyed 25 respondents at 20 unique sites, including 12 current, 5 planned, and 3 closed programs. Existing programs were located primarily in academic medical centers and served an average of 12.5 spoke sites (range, 1-30). Respondents identified five major barriers, including difficulties in cross-hospital credentialing, integration into established workflows, usability of technology, lack of physician buy-in, and misaligned incentives between patients and providers. Uneven reimbursement was also cited as a barrier, although this was not seen as major because most programs were able to operate independent of reimbursement, and many were not actively seeking reimbursement even when allowed. Critical success factors included selecting spoke hospitals based on receptivity rather than perceived need and cultivating clinical champions at local sites.
Although pediatric emergency telemedicine confronts many of the same challenges of other telemedicine applications, reimbursement is relatively less significant, and workflow disruption are relatively more significant in this setting. Although certain challenges such as credentialing can be addressed with available policy options, others such as the culture of transfer at rural emergency departments require innovative approaches.
儿科急诊远程医疗有潜力改善医疗服务不足地区的儿科急诊护理质量，减少获得护理方面的社会经济差异。然而，儿科急诊环境中的远程医疗仍未得到充分利用。我们旨在评估儿科急诊远程医疗的现状，并确定其广泛应用的独特成功因素和障碍。
我们对美国当前、以前和计划中的儿科急诊远程医疗项目进行了电话调查。
我们在20个不同地点对25名受访者进行了调查，包括12个当前项目、5个计划中的项目和3个已关闭的项目。现有项目主要位于学术医疗中心，平均服务12.5个分支站点（范围为1 - 30个）。受访者确定了五个主要障碍，包括跨医院资质认证困难、融入既定工作流程、技术可用性、医生缺乏支持以及患者与提供者之间激励措施不一致。报销不均衡也被视为一个障碍，不过这并不被视为主要障碍，因为大多数项目能够独立于报销运营，而且即使允许报销，许多项目也没有积极寻求报销。关键成功因素包括根据接受程度而非感知需求选择分支医院，以及在当地培养临床倡导者。
尽管儿科急诊远程医疗面临许多与其他远程医疗应用相同的挑战，但在这种情况下，报销相对不太重要，而工作流程中断相对更重要。虽然某些挑战（如资质认证）可以通过现有的政策选项解决，但其他挑战（如农村急诊科的转诊文化）则需要创新方法。
