University of Miami, Department of Neurosurgery, Miami, Florida.
Sylvester Comprehensive Cancer Center, Miami, Florida.
Neurosurgery. 2020 Dec 15;88(1):E1-E12. doi: 10.1093/neuros/nyaa306.
Evolving requirements for patient and physician safety and rapid regulatory changes have stimulated interest in neurosurgical telemedicine in the COVID-19 era.
To conduct a systematic literature review investigating treatment of neurosurgical patients via telemedicine, and to evaluate barriers and challenges. Additionally, we review recent regulatory changes that affect telemedicine in neurosurgery, and our institution's initial experience.
A systematic review was performed including all studies investigating success regarding treatment of neurosurgical patients via telemedicine. We reviewed our department's outpatient clinic billing records after telemedicine was implemented from 3/23/2020 to 4/6/2020 and reviewed modifier 95 inclusion to determine the number of face-to-face and telemedicine visits, as well as breakdown of weekly telemedicine clinic visits by subspecialty.
A total of 52 studies (25 prospective and 27 retrospective) with 45 801 patients were analyzed. A total of 13 studies were conducted in the United States and 39 in foreign countries. Patient management was successful via telemedicine in 99.6% of cases. Telemedicine visits failed in 162 cases, 81.5% of which were due to technology failure, and 18.5% of which were due to patients requiring further face-to-face evaluation or treatment. A total of 16 studies compared telemedicine encounters to alternative patient encounter mediums; telemedicine was equivalent or superior in 15 studies. From 3/23/2020 to 4/6/2020, our department had 122 telemedicine visits (65.9%) and 63 face-to-face visits (34.1%). About 94.3% of telemedicine visits were billed using face-to-face procedural codes.
Neurosurgical telemedicine encounters appear promising in resource-scarce times, such as during global pandemics.
患者和医生安全的不断发展的需求以及快速的监管变化刺激了 COVID-19 时代神经外科远程医疗的兴趣。
对通过远程医疗治疗神经外科患者的文献进行系统综述，评估障碍和挑战。此外，我们还回顾了最近影响神经外科远程医疗的监管变化以及我们机构的初步经验。
进行了一项系统综述，其中包括所有研究通过远程医疗治疗神经外科患者的成功情况。我们审查了我们部门从 2020 年 3 月 23 日至 4 月 6 日实施远程医疗后的门诊计费记录，并审查了Modifier 95 的纳入情况，以确定面对面和远程医疗访问的数量，以及每周远程医疗诊所访问的专科分类。
共分析了 52 项研究（25 项前瞻性研究和 27 项回顾性研究），共涉及 45,801 名患者。其中 13 项研究在美国进行，39 项在国外进行。通过远程医疗成功管理患者的比例为 99.6%。远程医疗访问失败 162 例，其中 81.5%是由于技术故障，18.5%是由于患者需要进一步的面对面评估或治疗。共有 16 项研究将远程医疗会诊与替代患者会诊媒介进行了比较；在 15 项研究中，远程医疗是等效或优越的。从 2020 年 3 月 23 日至 4 月 6 日，我们部门有 122 次远程医疗访问（65.9%）和 63 次面对面访问（34.1%）。约 94.3%的远程医疗访问使用面对面的程序代码计费。
在资源匮乏的时期，如全球大流行期间，神经外科远程医疗会诊似乎很有前途。
