重症监护病房远程医疗减少退伍军人健康管理局的医院间 ICU 转院。

ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health Administration.

机构信息

Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.

Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.

出版信息

Chest. 2018 Jul;154(1):69-76. doi: 10.1016/j.chest.2018.04.021. Epub 2018 Jun 15.

DOI:10.1016/j.chest.2018.04.021

PMID:29914751

Abstract

BACKGROUND

The effect of ICU telemedicine on transfers is not well studied. This study tests the hypothesis that ICU telemedicine decreases ICU patient interhospital transfers.

METHODS

Data were retrieved for patients admitted to 306 Veterans Affairs ICUs in 117 acute care facilities between 2011 and 2015. Telemedicine was provided to 52 ICUs in 23 acute care facilities by two support centers located in Minneapolis and Cincinnati. We compared interhospital transfer rates in ICU telemedicine-affiliated hospitals with transfer rates of facilities with no telemedicine program. We used generalized linear mixed multivariable models to assess the association of ICU telemedicine with transfer rates and 30-day mortality.

RESULTS

A total of 553,523 admissions to Veterans Affairs ICUs (97,256 to telemedicine hospitals; 456,267 to non-telemedicine hospitals) were analyzed. Transfers decreased from 3.46% to 1.99% in the telemedicine hospitals and from 2.03% to 1.68% in the non-telemedicine facilities between pre- and post-telemedicine implementation periods (P < .001). After adjusting for demographics, illness severity, admission diagnosis, and facility, ICU telemedicine was associated with overall reduced transfers with a relative risk (RR) of 0.79 (95% CI, 0.71-0.87; P < .001); this reduction occurred in patients with moderate (RR, 0.77; 95% CI, 0.61-0.98; P =.034), moderate to high (RR, 0.79; 95% CI, 0.63-0.98; P =.035), and high illness severity (RR, 0.73; 95% CI, 0.60-0.90; P =.003) and in nonsurgical patients (RR, 0.82; 95% CI, 0.73-0.92; P =.001). Transfers decreased in patients admitted with GI (RR, 0.55; 95% CI, 0.41-0.74, P < .001) and respiratory admission diagnoses (RR, 0.52; 95% CI, 0.38-0.71; P < .001). ICU telemedicine was not associated with an increase in 30-day mortality.

CONCLUSIONS

ICU telemedicine was associated with a decrease in interhospital ICU transfers.

摘要

背景

重症监护病房（ICU）远程医疗对转院的影响尚未得到充分研究。本研究检验了以下假设，即 ICU 远程医疗可降低 ICU 患者的院内转院率。

方法

本研究检索了 2011 年至 2015 年间在 117 家急性护理机构的 306 家退伍军人事务部 ICU 收治的 553523 名患者的数据。两个支持中心分别位于明尼阿波利斯和辛辛那提，为 23 家急性护理机构的 52 个 ICU 提供远程医疗服务。我们比较了 ICU 远程医疗附属医院的院内转院率与无远程医疗计划的医院的转院率。我们使用广义线性混合多变量模型评估 ICU 远程医疗与转院率和 30 天死亡率之间的关联。

结果

分析了退伍军人事务部 ICU 的 553523 例入院病例（远程医疗医院 97256 例，非远程医疗医院 456267 例）。在远程医疗实施前后，转院率从 3.46%降至 1.99%（P<.001）；非远程医疗设施的转院率从 2.03%降至 1.68%（P<.001）。在调整了人口统计学、疾病严重程度、入院诊断和机构因素后，ICU 远程医疗与整体转院率降低相关，相对风险（RR）为 0.79（95%CI，0.71-0.87；P<.001）；这种降低发生在中度（RR，0.77；95%CI，0.61-0.98；P=.034）、中度至高度（RR，0.79；95%CI，0.63-0.98；P=.035）和高度疾病严重程度（RR，0.73；95%CI，0.60-0.90；P=.003）患者中，以及非手术患者（RR，0.82；95%CI，0.73-0.92；P=.001）中。转院率在因 GI（RR，0.55；95%CI，0.41-0.74，P<.001）和呼吸入院诊断（RR，0.52；95%CI，0.38-0.71，P<.001）的患者中降低。ICU 远程医疗与 30 天死亡率的增加无关。