学术医疗中心向初级保健视频问诊的快速系统转型的定性评估。
Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center.
机构信息
Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.).
Stanford University School of Medicine and Intermountain Delivery Institute, Intermountain Healthcare, Palo Alto, California (S.C.T.).
出版信息
Ann Intern Med. 2020 Oct 6;173(7):527-535. doi: 10.7326/M20-1814. Epub 2020 Jul 6.
BACKGROUND
The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits.
OBJECTIVE
To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits.
DESIGN
Semistructured qualitative interviews.
SETTING
6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019.
PARTICIPANTS
53 program participants (overlapping roles as medical providers [ = 20], medical assistants [ = 16], nurses [ = 4], technologists [ = 4], and administrators [ = 13]) were interviewed about video visit transition and challenges.
INTERVENTION
In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method.
MEASUREMENTS
9 faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used.
RESULTS
The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization.
LIMITATIONS
Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability.
CONCLUSION
After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being.
PRIMARY FUNDING SOURCE
Stanford Department of Medicine and Stanford Health Care.
背景
2019 年冠状病毒病大流行促使世界各地的卫生系统迅速将面对面就诊转变为更安全的视频就诊。
目的
在接近全面转向视频就诊后 3 周，寻求利益相关者对视频就诊可接受性和效果的看法。
设计
半结构式定性访谈。
地点
加利福尼亚州北部 6 个地点的斯坦福综合初级保健和快速护理 6 个诊所，2019 年有 81 名提供者、123 名工作人员和 97614 名患者就诊。
参与者
53 名项目参与者（重叠角色为医疗提供者[=20]、医疗助理[=16]、护士[=4]、技术员[=4]和管理人员[=13]）接受了有关视频就诊过渡和挑战的采访。
干预措施
在 3 周内，快速护理和初级保健的视频就诊量分别从不到 10%增加到 80%以上和从不到 10%增加到 75%以上。新的视频就诊提供者接受了视频就诊培训和护理质量反馈。创建了新的系统工作流程以适应新的就诊方式。
测量
9 位接受过定性研究方法培训的教师在 4 天内使用有针对性（管理员和技术员）和方便（医疗助理、护士和提供者）抽样方法进行了 53 次利益相关者访谈。使用主题分析的快速定性分析方法进行分析。
结果
分析显示出 12 个主题，包括大流行作为催化剂；医学的快乐；医学中的安全；漏洞百出；重新定义我的角色；新常态。使用 RE-AIM（覆盖范围、效果、采用、实施和维护）框架分析主题，以确定继续使用计划的关键问题。
局限性
评估是在部署后立即进行的。尽管观点可能后来发生了演变，但及时评估允许及时进行计划更改，并确定计划可持续性需要解决的更广泛问题。
结论
斯坦福大学在与大流行相关的系统转型后，确定了维持视频就诊长期可行性的关键问题。具体来说，必须提高技术易用性并支持多方视频会议。无论地理位置如何，提供者都应该能够照顾他们的病人。提供者需要虚拟检查培训和基于家庭的患者诊断的决策支持。最后，持续的视频就诊报销应与患者的健康和福祉的价值相称。
主要资金来源
斯坦福大学医学系和斯坦福健康保健。
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