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针对新冠疫情的新型虚拟医疗士兵战备处理流程的回顾性研究

Retrospective Review of a Novel Virtual Medical Soldier Readiness Processing Process in Response to the COVID-19 Pandemic.

作者信息

Ramirez Ariana, Owshalimpur David, Mount Cristin, Schofield Christina

机构信息

Department of Internal Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA.

出版信息

Mil Med. 2021 Jul 1;186(7-8):651-655. doi: 10.1093/milmed/usaa580.

Abstract

INTRODUCTION

Medical solider readiness processing (SRP) needed to continue during the COVID-19 pandemic. We developed a rapid practice improvement project to allow for a hybrid virtual medical SRP/in-person medical SRP to decrease exposure risk. A retrospective review comparing this virtual SRP to a historical in-person SRP cohort to the same combatant command was then performed.

PROCEDURES

A virtual medical SRP was completed for 204 soldiers in preparation for deployment within 24 hours of receiving the deployment roster. Each soldier had their MEDPROS data sheet printed and reviewed for deficiencies. Soldiers were then divided into two groups. Group 1 required hybrid SRP with need for in-person labs or vaccinations. Group 2 had no deficiencies noted on MEDPROS review, and the entire medical SRP was done virtually. Pre-deployment health assessment (pre-DHA) was completed over the phone for both groups. The provider then determined whether the soldier was a GO or NO GO, and this information was passed to the unit's medical staff. Comparative data analysis was performed using t-tests assuming unequal variances and chi-square tests.

INFORMATION FOUND

A total of 204 soldiers were expected to complete the virtual SRP process. Of those 204, 191 MEDPROS records were reviewed (93%). Seventy-seven of the 191 soldiers (40%) required level one labs and immunizations, had not completed their pre-DHA, or had a combination of these factors. One hundred and fourteen soldiers (60%) had these items completed and were given virtual appointments in GENESIS. One hundred and six of the 114 (95%) soldiers were able to complete their medical SRP virtually. Eighty-six soldiers (80%) of this cohort were a GO for deployment at the end of their virtual SRP visit.The novel virtual SRP process was comparable to the historic in-person SRP as evidenced by no statistically significant difference in terms of the number of providers required and the number of soldiers that was seen by any one provider. The groups did show statistically significant differences based on age, gender, and GOs/NO GOs.

CONCLUSION

This is the first proof of concept of a virtual medical SRP on literature review. A virtual SRP process that combines a pre-visit record review with a virtual pre-DHA is a viable process for SRP. The ability to utilize providers outside of a confined location or post may allow for optimized utilization of this scarce resource and result in cost savings to the Army. The recreation of this virtual medical SRP within other Army installations may allow for the improvement and standardization of the medical SRP process as a whole.

摘要

引言

在新冠疫情期间,军事人员医疗准备程序(SRP)需要继续进行。我们开展了一个快速实践改进项目,以实现虚拟医疗SRP与面对面医疗SRP相结合,降低暴露风险。随后进行了一项回顾性研究,将这种虚拟SRP与同一作战司令部的历史面对面SRP队列进行比较。

程序

为204名士兵完成了虚拟医疗SRP,以便他们在收到部署名册后的24小时内为部署做准备。为每名士兵打印了MEDPROS数据表并检查是否存在缺陷。士兵们随后被分为两组。第1组需要混合SRP,即需要进行面对面的实验室检查或接种疫苗。第2组在MEDPROS检查中未发现缺陷,整个医疗SRP均通过虚拟方式完成。两组均通过电话完成了部署前健康评估(pre-DHA)。然后,医疗服务提供者确定该士兵是否可以部署,此信息会传递给部队的医务人员。使用假设方差不相等的t检验和卡方检验进行比较数据分析。

发现的信息

预计共有204名士兵完成虚拟SRP流程。在这204人中,审查了191份MEDPROS记录(93%)。191名士兵中有77人(40%)需要进行一级实验室检查和接种疫苗、尚未完成pre-DHA或存在这些因素的组合。114名士兵(60%)完成了这些项目,并在GENESIS中获得了虚拟预约。114名士兵中有106人(95%)能够通过虚拟方式完成他们的医疗SRP。该队列中的86名士兵(80%)在虚拟SRP就诊结束时可以部署。这种新型虚拟SRP流程与历史面对面SRP相当,这一点从所需医疗服务提供者数量以及任何一名医疗服务提供者接待的士兵数量方面无统计学显著差异得到证明。两组在年龄、性别以及可部署/不可部署方面确实显示出统计学显著差异。

结论

这是文献综述中关于虚拟医疗SRP的首个概念验证。将就诊前记录审查与虚拟pre-DHA相结合的虚拟SRP流程是一种可行的SRP流程。能够在有限地点或驻地之外利用医疗服务提供者,可能会优化这种稀缺资源的利用,并为陆军节省成本。在其他陆军设施中重现这种虚拟医疗SRP,可能会使整个医疗SRP流程得到改进和标准化。

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