Waibel Kirk H, Cain Steven M, Hall Todd E, Keen Ronald S
Regional Telehealth Department, Landstuhl Regional Medical Center, Ward 4D, Building 3766, Landstuhl, Germany.
Mil Med. 2017 Jul;182(7):e1693-e1697. doi: 10.7205/MILMED-D-16-00368.
Telehealth implementation within the Military Healthcare System continues to advance toward the goal of a mature regional health platform; however, specialty-specific usage or patient satisfaction regarding synchronous or "real-time" telehealth at the regional military hospital level has not been described.
A retrospective review of synchronous telehealth encounters and patient satisfaction surveys from Landstuhl Regional Medical Center (LRMC) specialty clinics engaging in synchronous telehealth to regional Army Health Clinics (AHCs) during 2015 was conducted.
2,354 synchronous telehealth encounters were conducted for 1,886 unique patients. The majority of patients were adults (88.4%), male (71.1%), and active duty (75%). Twelve distinct distant locations were engaged in synchronous telehealth with 31 distinct specialties. 1,552 (62.5%) patients had a single telehealth visit with a median (range) of 1 (1-7) visit. Median (range) visits per specialty was 25 (1-582) with sleep medicine (24.7%), general surgery (13.1%), nutrition (9.7%), orthopedics (9.0%), and ENT (6.0%) representing 62.5% of all encounters. Median (range) number of encounters per location was 146 (13-685). Surgical specialties preferentially evaluated patients at locations with a specialty-trained presenter (p < 0.001), whereas nonsurgical specialties did not (p > 0.05). Fifteen percent (372/2,354) of patients completed an anonymous survey at the time of their telehealth visit. Mean responses on a 5-point Likert scale ranging from "strongly disagree" (1) to "strongly agree" (5) was 4.8 ± 0.5 for both recommending and being satisfied with their telehealth visit. The 2,354 telehealth visits represented 2.4% (2,354/100,094) of all visits to LRMC during 2015 for 25 of 31 specialties whose total outpatient visits could be determined.
Clinic utilization varied between specialties as well as whether a specialty-trained patient presenter was preferred. This robust multispecialty synchronous telehealth experience provides insight into both specialty-specific utilization and patient satisfaction which may aid regional medical centers recognizing avenues for specialty-specific telehealth initiatives.
军事医疗系统中的远程医疗实施继续朝着成熟的区域健康平台目标迈进；然而，尚未描述地区军事医院层面特定专科对同步或“实时”远程医疗的使用情况或患者满意度。
对2015年期间兰施图尔地区医疗中心（LRMC）各专科诊所与地区陆军健康诊所（AHC）进行同步远程医疗的同步远程医疗会诊及患者满意度调查进行回顾性研究。
为1886名不同患者进行了2354次同步远程医疗会诊。大多数患者为成年人（88.4%）、男性（71.1%）且为现役军人（75%）。与12个不同的远程地点进行了同步远程医疗，涉及31个不同专科。1552名（62.5%）患者进行了单次远程医疗会诊，中位数（范围）为1次（1 - 7次）会诊。每个专科的会诊中位数（范围）为25次（1 - 582次），其中睡眠医学（24.7%）、普通外科（13.1%）、营养科（9.7%）、骨科（9.0%）和耳鼻喉科（6.0%）占所有会诊的62.5%。每个地点的会诊中位数（范围）为146次（13 - 685次）。外科专科更倾向于在有专科培训主持人的地点评估患者（p < 0.001），而非外科专科则不然（p > 0.05）。15%（372/2354）的患者在远程医疗会诊时完成了匿名调查。在5分李克特量表上，从“强烈不同意”（1）到“强烈同意”（5），患者对远程医疗会诊的推荐度和满意度平均回复均为4.8 ± 0.5。2015年，在31个可确定门诊总量专科中的25个专科里，这2354次远程医疗会诊占LRMC所有就诊量的2.4%（2354/100094）。
各专科之间的诊所利用率存在差异，且是否偏好专科培训的患者主持人也有所不同。这种丰富的多专科同步远程医疗经验为特定专科的利用率和患者满意度提供了见解，这可能有助于地区医疗中心识别特定专科远程医疗举措的途径。
