Heppner Sarah, Mohr Nicholas M, Carter Knute D, Ullrich Fred, Merchant Kimberly A S, Ward Marcia M
Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, United States of America.
Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America.
PLoS One. 2021 Jan 12;16(1):e0243211. doi: 10.1371/journal.pone.0243211. eCollection 2021.
The Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy (FORHP) funded the Evidence-Based Tele-Emergency Network Grant Program (EB TNGP) to serve the dual purpose of providing telehealth services in rural emergency departments (teleED) and systematically collecting data to inform the telehealth evidence base. This provided a unique opportunity to examine trends across multiple teleED networks and examine heterogeneity in processes and outcomes.
Six health systems received funding from HRSA under the EB TNGP to implement teleED services and they did so to 65 hospitals (91% rural) in 11 states. Three of the grantees provided teleED services to a general patient population while the remaining three grantees provided teleED services to specialized patient populations (i.e., stroke, behavioral health, critically ill children). Over a 26-month period (November 1, 2015 -December 31, 2017), each grantee submitted patient-level data for all their teleED encounters on a uniform set of measures to the data coordinating center. The six grantees reported a total of 4,324 teleED visits and 99.86% were technically successful. The teleED patients were predominantly adult, White, not Latinx, and covered by Medicare or private insurance. Across grantees, 7% of teleED patients needed resuscitation services, 58% were rated as emergent, and 30% were rated as urgent. Across grantees, 44.2% of teleED patients were transferred to another inpatient facility, 26.0% had a routine discharge, and 24.5% were admitted to the local inpatient facility. For the three grantees who served a general patient population, the most frequent presenting complaints for which teleED was activated were chest pain (25.7%), injury or trauma (17.1%), stroke symptoms (9.9%), mental/behavioral health (9.8%), and cardiac arrest (9.5%). The teleED consultation began before the local clinician exam in 37.8% of patients for the grantees who served a general patient population, but in only 1.9% of patients for the grantees who provided specialized services.
Grantees used teleED services for a representative rural population with urgent or emergent symptoms largely resulting in transfer to a distant hospital or inpatient admission locally. TeleED was often available as the first point of contact before a local provider examination. This finding points to the important role of teleED in improving access for rural ED patients.
美国卫生资源与服务管理局（HRSA）下属的联邦农村卫生政策办公室（FORHP）资助了循证远程急诊网络资助项目（EB TNGP），其具有双重目的，即在农村急诊科提供远程医疗服务（teleED），并系统地收集数据以充实远程医疗的证据基础。这提供了一个独特的机会来研究多个远程急诊网络的趋势，并考察流程和结果的异质性。
六个医疗系统根据EB TNGP从HRSA获得资金，以实施远程急诊服务，它们在11个州的65家医院（91%为农村医院）开展了此项服务。其中三个受资助方为普通患者群体提供远程急诊服务，其余三个受资助方为特殊患者群体（即中风、行为健康、危重症儿童）提供远程急诊服务。在26个月期间（2015年11月1日至2017年12月31日），每个受资助方将其所有远程急诊会诊的患者层面数据按照一套统一的指标提交给数据协调中心。这六个受资助方共报告了4324次远程急诊就诊，技术成功率为99.86%。远程急诊患者主要为成年白人，非拉丁裔，由医疗保险或私人保险承保。在各受资助方中，7%的远程急诊患者需要复苏服务，58%被评为紧急情况，30%被评为 urgent（此处原文有误，结合语境推测应为“urgent”，意为“紧急的”）。在各受资助方中，44.2%的远程急诊患者被转至另一家住院机构，26.0%为常规出院，24.5%被收治到当地住院机构。对于为普通患者群体提供服务的三个受资助方，激活远程急诊的最常见就诊主诉为胸痛（25.7%）、损伤或创伤（17.1%）、中风症状（9.9%）、精神/行为健康（9.8%）和心脏骤停（9.5%）。对于为普通患者群体提供服务的受资助方，37.8%的患者在当地临床医生检查之前就开始了远程急诊会诊，但对于提供特殊服务的受资助方，这一比例仅为1.9%。
受资助方将远程急诊服务用于有紧急或急症症状的代表性农村人群，很大程度上导致患者被转至远处医院或在当地住院。在当地医疗服务提供者检查之前，远程急诊通常可作为首个接触点。这一发现表明远程急诊在改善农村急诊科患者就医机会方面发挥着重要作用。
