远程 ICU 治疗 COVID-19：观察全国范围内提供远程重症监护的医院的流行情况和特点。
Tele-ICUs for COVID-19: A Look at National Prevalence and Characteristics of Hospitals Providing Teleintensive Care.
机构信息
Department of Health Care Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
Center for the Advancement of Team Science, Analysis, and Systems Thinking in Health Services and Implementation Science Research and the Biomedical Sciences Graduate Program, Ohio State University, Columbus, Ohio.
出版信息
J Rural Health. 2021 Jan;37(1):133-141. doi: 10.1111/jrh.12524. Epub 2020 Oct 8.
PURPOSE
Amidst the COVID-19 outbreak, the use of intensive care unit telemedicine (tele-ICUs) may be one mechanism to provide patient care, particularly in rural parts of the United States. The purpose of this research was to inform hospital decision makers considering tele-ICUs, policy makers weighing immediate and longer-term funding and reimbursement decisions relative to tele-ICU care, and researchers conducting future work evaluating tele-ICUs.
METHODS
We compared hospitals that reported providing teleintensive care to hospitals that reported not providing teleintensive care in the 2018 American Hospital Association Annual Survey (AHAAS). Differences between groups were tested using Pearson's chi-square (categorical variables) and t-tests (continuous variables) using 0.05 as the probability of Type 1 error. The study sample included all US short-term, acute care hospitals that responded to the AHAAS in 2018. Our key variable of interest was whether a hospital reported having any tele-ICU capabilities in the 2018 AHAAS. Other factors evaluated were ownership, region, beds, ICU beds, outpatient visits, emergency department visits, full-time employees, and whether a hospital was rural, a critical access hospital, a major teaching hospital, or part of a health system.
FINDINGS
Larger, not-for-profit, nonrural, noncritical access, teaching hospitals that were part of a health system, particularly in the Midwest, were more likely to have tele-ICUs. Over one-third of hospital referral regions (HRRs) had zero hospitals with tele-ICUs, 4 had all hospitals with tele-ICU, and the median percent of hospitals with tele-ICU by HRR, weighted by outpatient visits, was 11.3%.
CONCLUSIONS AND IMPLICATIONS
We found wide variation in the prevalence of tele-ICUs across HRRs and states. Future work should continue the evaluation of tele-ICU effectiveness and, if favorable, explore the variation we identified for improved access to teleintensive care.
目的
在 COVID-19 疫情期间，使用重症监护病房远程医疗（远程 ICU）可能是提供患者护理的一种机制，特别是在美国的农村地区。本研究的目的是为考虑远程 ICU 的医院决策者、权衡与远程 ICU 护理相关的即时和长期资金和报销决策的政策制定者，以及评估远程 ICU 的未来工作的研究人员提供信息。
方法
我们比较了在 2018 年美国医院协会年度调查（AHAAS）中报告提供远程重症监护的医院与报告不提供远程重症监护的医院。使用 Pearson's chi-square（分类变量）和 t 检验（连续变量）比较组间差异，使用 0.05 作为 Type 1 错误的概率。研究样本包括 2018 年 AHAAS 中回复的所有美国短期、急性护理医院。我们感兴趣的关键变量是医院在 2018 年 AHAAS 中是否报告具有任何远程 ICU 能力。评估的其他因素包括所有权、区域、床位、ICU 床位、门诊就诊量、急诊就诊量、全职员工，以及医院是否为农村、关键访问医院、主要教学医院或医疗系统的一部分。
结果
更大、非营利、非农村、非关键访问、教学医院，特别是在中西部地区，属于医疗系统的医院更有可能拥有远程 ICU。超过三分之一的医院转诊区（HRR）没有一家医院拥有远程 ICU，4 家医院全部拥有远程 ICU，按门诊就诊量加权的 HRR 中拥有远程 ICU 的医院中位数百分比为 11.3%。
结论和意义
我们发现 HRR 和州之间远程 ICU 的普及率存在很大差异。未来的工作应该继续评估远程 ICU 的效果，如果效果良好，应该探索我们发现的改善远程重症监护服务的差异。
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