1 Renal Transplant, US Department of Veterans Affairs Hospital, Tennessee Valley, Nashville, TN, USA.
2 Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, TN, USA.
J Telemed Telecare. 2018 Aug;24(7):485-491. doi: 10.1177/1357633X17715526. Epub 2017 Jun 26.
Introduction The United States Department of Veterans Affairs (VA) National Transplant Program has made efforts to improve access by introducing Web-based referrals and telehealth. The aims of this study were to describe the programmatic implementation and evaluate the effectiveness of new technology on the timeliness to kidney transplant evaluation at a VA medical centre. Methods Between 1 January 2009 and 31 May 2016, 835 patients were approved for evaluation. Monthly data were summarized as: number of applications, median days to evaluation, and median percentage of evaluations that occurred within 30 days. Temporal trends were analysed using non-parametric comparisons of medians between three eras: Pre Web-based submission, Web-based submission, and Web-based submission with videoconference (VC) telehealth. Results The number of applications did not vary between eras ( p = 0.353). The median time to evaluation and the median percentage of patients with appointments within 30 days improved significantly in the Web-based submission with VC era when compared with the Web-based and Pre Web-based eras (37 vs. 260 and 116 days, respectively, p < 0.001; 100% vs. 8% and 0%, respectively, p < 0.001). Discussion We have been able to markedly improve the timeliness to kidney transplant waitlist evaluation with the addition of telehealth.
简介 美国退伍军人事务部（VA）国家移植项目通过引入基于网络的转诊和远程医疗服务，努力提高可及性。本研究的目的是描述该项目的实施情况，并评估新技术在 VA 医疗中心对肾脏移植评估及时性方面的效果。
方法 2009 年 1 月 1 日至 2016 年 5 月 31 日期间，共有 835 名患者获得评估批准。每月数据总结为：申请人数、评估中位数天数以及 30 天内完成评估的中位数百分比。采用非参数比较中位数的方法分析三个时期（基于网络提交前、基于网络提交和基于网络提交与视频会议远程医疗）的时间趋势。
结果 各时期的申请人数没有差异（p=0.353）。与基于网络提交和基于网络提交前时期相比，基于网络提交和视频会议远程医疗时期的评估中位数时间和 30 天内预约的中位数百分比显著改善（分别为 37 天与 260 天和 116 天，p<0.001；分别为 100%与 8%和 0%，p<0.001）。
讨论 我们通过增加远程医疗服务，大大提高了肾脏移植候补者评估的及时性。
