All authors: Telehealth Center of Excellence, Baptist Health South Florida, Coral Gables, FL.
Crit Care Med. 2018 May;46(5):728-735. doi: 10.1097/CCM.0000000000002994.
To determine whether Telemedicine intervention can affect hospital mortality, length of stay, and direct costs for progressive care unit patients.
Retrospective observational.
Large healthcare system in Florida.
Adult patients admitted to progressive care unit (PCU) as their primary admission between December 2011 and August 2016 (n = 16,091).
Progressive care unit patients with telemedicine intervention (telemedicine PCU [TPCU]; n = 8091) and without telemedicine control (nontelemedicine PCU [NTPCU]; n = 8000) were compared concurrently during study period.
Primary outcome was progressive care unit and hospital mortality. Secondary outcomes were hospital length of stay, progressive care unit length of stay, and mean direct costs. The mean age NTPCU and TPCU patients were 63.4 years (95% CI, 62.9-63.8 yr) and 71.1 years (95% CI, 70.7-71.4 yr), respectively. All Patient Refined-Diagnosis Related Group Disease Severity (p < 0.0001) and All Patient Refined-Diagnosis Related Group patient Risk of Mortality (p < 0.0001) scores were significantly higher among TPCU versus NTPCU. After adjusting for age, sex, race, disease severity, risk of mortality, hospital entity, and organ systems, TPCU survival benefit was 20%. Mean progressive care unit length of stay was lower among TPCU compared with NTPCU (2.6 vs 3.2 d; p < 0.0001). Postprogressive care unit hospital length of stay was longer for TPCU patients, compared with NTPCU (7.3 vs 6.8 d; p < 0.0001). The overall mean direct cost was higher for TPCU ($13,180), compared with NTPCU ($12,301; p < 0.0001).
Although there are many studies about the effects of telemedicine in ICU, currently there are no studies on the effects of telemedicine in progressive care unit settings. Our study showed that TPCU intervention significantly decreased mortality in progressive care unit and hospital and progressive care unit length of stay despite the fact patients in TPCU were older and had higher disease severity, and risk of mortality. Increased postprogressive care unit hospital length of stay and total mean direct costs inclusive of telemedicine costs coincided with improved survival rates. Telemedicine intervention decreased overall mortality and length of stay within progressive care units without substantial cost incurrences.
确定远程医疗干预是否会影响重症监护病房患者的住院死亡率、住院时间和直接费用。
回顾性观察性研究。
佛罗里达州的大型医疗保健系统。
2011 年 12 月至 2016 年 8 月期间，作为主要入院患者入住重症监护病房（PCU）的成年患者（n=16091）。
在研究期间，将接受远程医疗干预的重症监护病房患者（远程医疗 PCU[TPCU]；n=8091）与未接受远程医疗对照的患者（非远程医疗 PCU[NTPCU]；n=8000）进行同期比较。
主要结局为重症监护病房和医院死亡率。次要结局为医院住院时间、重症监护病房住院时间和平均直接费用。NTPCU 和 TPCU 患者的平均年龄分别为 63.4 岁（95%CI，62.9-63.8 岁）和 71.1 岁（95%CI，70.7-71.4 岁）。所有患者改良诊断相关组疾病严重程度（p<0.0001）和所有患者改良诊断相关组患者死亡风险（p<0.0001）评分在 TPCU 中明显高于 NTPCU。在调整年龄、性别、种族、疾病严重程度、死亡风险、医院实体和器官系统后，TPCU 的生存率提高了 20%。与 NTPCU 相比，TPCU 的重症监护病房住院时间更短（2.6 天 vs. 3.2 天；p<0.0001）。与 NTPCU 相比，TPCU 患者的出院后医院住院时间更长（7.3 天 vs. 6.8 天；p<0.0001）。TPCU 的总体平均直接费用（13180 美元）高于 NTPCU（12301 美元；p<0.0001）。
尽管有许多关于 ICU 中远程医疗效果的研究，但目前尚无关于重症监护病房中远程医疗效果的研究。我们的研究表明，尽管 TPCU 中的患者年龄更大，疾病严重程度和死亡风险更高，但 TPCU 干预显著降低了重症监护病房和医院的死亡率以及重症监护病房的住院时间。尽管提高了生存率，但增加的出院后医院住院时间和包括远程医疗费用在内的总平均直接费用。远程医疗干预降低了重症监护病房的总体死亡率和住院时间，而不会产生实质性的成本增加。
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