Cota Adam, Tarchala Magdalena, Parent-Harvey Caroline, Engel Victor, Berry Greg, Reindl Rudy, Harvey Edward J
Division of Orthopaedic Surgery, McGill University Health Centre , Montreal, Canada .
Telemed J E Health. 2017 Jan;23(1):37-40. doi: 10.1089/tmj.2016.0030. Epub 2016 Jun 23.
The use of e-mail-based telemedicine has been demonstrated as an effective and low-cost way of delivering healthcare to patients in remote areas who have limited access to medical services. We established a novel teleorthopedic service for a catchment area encompassing 972,000 km using a commercial off-the-shelf e-mail application. Before the implementation of this program, patients with acute orthopedic injuries were required to travel by air up to 1,900 km for evaluation by an orthopedic surgeon. In the present study, we examined the patient demographics and consultation characteristics and calculated the cost savings associated with patient travel for this teleorthopedic service.
We retrospectively reviewed 1,000 consecutive e-mail-based consults and radiographic images received for new patients with acute orthopedic injuries from January 2008 to June 2013. Seventy-nine consults were excluded due to incomplete documentation, leaving 921 available for analysis. The service records were examined to identify patient demographics, orthopedic diagnosis, the percentage of patients managed locally, and the medical indications for patients requiring transfer. As the travel costs for patients requiring transport to the university hospital center are borne by governmental health agencies, the savings accrued from treating patients in their home communities were also calculated.
For the 921 consultations, the mean age of patients was 27 years (range, 3 months-88 years), with 40.7% of all patients being younger than 18 years. The most common diagnoses were ankle fractures (15.2%), clavicle fractures (11.2%), distal radius fractures (11.2%), and fractures of the foot (10.2%). One hundred ninety patients (20.6%) required transfer, whereas 731 patients (79.4%) were treated in their home communities. Of the patients who were transferred, 123 (64.7%) required surgery, 55 (28.9%) required clinical evaluation by an orthopedic surgeon, and 12 (6.4%) required CT or MRI. Cost savings related to return trip travel expenses were calculated to be $5,538,120 Canadian (CAD) for the review period.
Using an e-mail-based teleorthopedic service to manage acutely injured patients in remote communities allowed 79% of patients to be treated locally, with travel-related cost savings of $5,538,120 CAD.
基于电子邮件的远程医疗已被证明是一种有效且低成本的方式，可为偏远地区医疗服务获取受限的患者提供医疗保健。我们利用一款现成的商业电子邮件应用程序，为一个面积达97.2万平方公里的服务区域建立了一项新型远程骨科服务。在该项目实施之前，急性骨科损伤患者需要乘坐飞机前往最远1900公里外的地方，由骨科医生进行评估。在本研究中，我们调查了患者的人口统计学特征和会诊特点，并计算了这项远程骨科服务在患者交通费用方面节省的成本。
我们回顾性分析了2008年1月至2013年6月期间连续收到的1000例基于电子邮件的新急性骨科损伤患者会诊及X光影像资料。因记录不完整排除79例会诊，剩余921例可供分析。检查服务记录以确定患者人口统计学特征、骨科诊断、在当地接受治疗的患者比例以及需要转诊患者的医疗指征。由于需要转运至大学医院中心的患者的交通费用由政府卫生机构承担，因此还计算了在患者所在社区治疗所节省的费用。
在921例会诊中，患者的平均年龄为27岁（范围3个月至88岁），所有患者中有40.7%年龄小于18岁。最常见的诊断为踝关节骨折（15.2%）、锁骨骨折（11.2%）、桡骨远端骨折（11.2%）和足部骨折（10.2%）。190例患者（20.6%）需要转诊，而731例患者（79.4%）在其所在社区接受治疗。在需要转诊的患者中，123例（64.7%）需要手术，55例（28.9%）需要骨科医生进行临床评估，12例（6.4%）需要CT或MRI检查。在审查期间，与往返交通费用相关的成本节省计算为5538120加元（CAD）。
使用基于电子邮件的远程骨科服务管理偏远社区的急性受伤患者，使79%的患者能够在当地接受治疗，节省了5538120加元与交通相关的成本。
