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通过电话进行术前评估可减少脑瘫患儿家庭的出行和费用。

Pre-surgery evaluations by telephone decrease travel and cost for families of children with cerebral palsy.

作者信息

Robinson John D, Prochaska John D, Yngve David A

机构信息

Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.

Department of Preventive Medicine & Community Health, The University of Texas Medical Branch, Galveston, TX, USA.

出版信息

SAGE Open Med. 2017 Jul 23;5:2050312117720046. doi: 10.1177/2050312117720046. eCollection 2017.

Abstract

INTRODUCTION

Children with cerebral palsy need highly specialized care. This can be very burdensome for families, particularly in large rural states, due to the need for long-distance travel to appointments. In this study, children undergoing the selective percutaneous myofascial lengthening surgery utilized a telephone-based telemedicine evaluation to assess for surgical eligibility. The goal was to avoid a separate preoperative clinic visit weeks before the surgery. If possible, eligibility was determined by telephone, and then, the patient could be scheduled for a clinic visit and possible surgery the next day, saving the family a trip. The purposes of the study were to calculate estimated reductions in miles traveled, in travel expenses, and in carbon emissions and to determine whether the telephone assessment was accurate and effective in determining eligibility for surgery.

METHODS

From 2010 to 2012, 279 patients were retrospectively reviewed, and of those, 161 mailed four-page questionnaire and anteroposterior pelvis X-ray followed by a telephone conference. Geographic information system methods were used to geocode patients by location. Savings in mileage and travel costs were calculated. From 2014 to 2015, 195 patients were additionally studied to determine accuracy and effectiveness.

RESULTS

The telephone prescreening method saved 106,070 miles in transportation over 3 years, a 38% reduction with US$55,326 in savings. Each family saved an average of 658 (standard deviation = 340) miles of travel and US$343.64 (standard deviation = US$178) in travel expenses. For each increase of 10 miles in distance from the health center, the odds of a patient utilizing telephone screening increased by 10% (odds ratio: 1.101, 95% confidence interval: 1.073-1.129, p < 0.001). After the telephone prescreening, 86% were determined to be likely candidates for the procedure. For 14%, a clinic visit only was scheduled, and they were not scheduled for surgery.

CONCLUSION

Families seeking specialized surgical care for their disabled children particularly benefited from this approach.

摘要

引言

脑瘫患儿需要高度专业化的护理。对于家庭来说,这可能非常繁重,尤其是在幅员辽阔的农村地区,因为需要长途跋涉去就医。在本研究中,接受选择性经皮肌筋膜延长手术的患儿利用基于电话的远程医疗评估来确定手术资格。目的是避免在手术前几周进行单独的术前门诊就诊。如果可能,通过电话确定资格,然后患者可以安排在第二天进行门诊就诊和可能的手术,为家庭节省一趟行程。该研究的目的是计算出行里程、差旅费和碳排放量的估计减少量,并确定电话评估在确定手术资格方面是否准确有效。

方法

对2010年至2012年的279例患者进行回顾性研究,其中161例邮寄了四页问卷和骨盆前后位X线片,随后进行电话会议。使用地理信息系统方法根据位置对患者进行地理编码。计算里程和差旅费的节省情况。2014年至2015年,另外对195例患者进行研究以确定准确性和有效性。

结果

电话预筛查方法在3年内节省了106,070英里的交通里程,减少了38%,节省了55,326美元。每个家庭平均节省了658(标准差=340)英里的行程和343.64美元(标准差=178美元)的差旅费。与医疗中心的距离每增加10英里,患者使用电话筛查的几率就增加10%(优势比:1.101,95%置信区间:1.073-1.129,p<0.001)。电话预筛查后,86%的患者被确定可能适合该手术。14%的患者仅安排了门诊就诊,未安排手术。

结论

为残疾儿童寻求专业手术护理的家庭尤其受益于这种方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d93/5528192/d651b2279ea7/10.1177_2050312117720046-fig1.jpg

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