Reddy Akhila, Arthur Joseph, Dalal Shalini, Hui David, Subbiah Ishwaria, Wu Jimin, Anderson Aimee E, Castro Debra, Joy Manju, Nweke Chinelo, Gogineni Meghana, Maddi Rama, de Moraes Aline Rozman, Shelal Zeena, Bruera Eduardo
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Palliat Med. 2021 Sep;24(10):1467-1473. doi: 10.1089/jpm.2020.0737. Epub 2021 Feb 2.
COVID-19 pandemic necessitated rapid adoption of telemedicine at our supportive care center (SCC) to ensure continuity of care while maintaining social distancing. To document the process of transition from in-person to virtual care. The charts of 1744 consecutive patients in our SCC located in the United States were retrospectively reviewed during the four weeks before transition (February 14-March 12), four weeks after transition (March 20-April 16), and transition week (March 13-March 19). Patient demographics, vital aspects of a supportive care visit such as assessments (Edmonton Symptom Assessment Scale-Financial and Spiritual [ESAS-FS], Cut-down, Annoyed, Guilty, Eye-opener Screen-Adapted to Include Drugs [CAGE-AID], and Memorial Delirium Assessment Scale [MDAS]), interdisciplinary team involvement, and visit type were recorded. In total 763 patients were seen before transition, 168 during the transition week, and 813 after transitioning to virtual care. Patient characteristics, ESAS-FS, CAGE-AID, and nurse assessment did not significantly differ among the three groups. The after-transition group had a small reduction in counseling intervention compared with before (20.2% vs. 26.2%; = 0.0068). MDAS completion was higher after transition (99.6% vs. 98%; = 0.007). In-person visits decreased from 100% before to 12.7% after transition ( < 0.0001) and virtual visits increased to 49.3% (video) and 38% (telephone). In-person visits decreased to 49% in the week one, 3% in week two, and <2% in week four after transition ( < 0.0001). Our supportive care team transitioned from in-person care to virtual visits within weeks while maintaining a high patient volume, continuity of care, and adherence to social distancing. Our transition can serve as a model for other centers.
新冠疫情使得我们的支持性护理中心（SCC）迅速采用远程医疗，以确保在保持社交距离的同时护理的连续性。为记录从面对面护理向虚拟护理的转变过程，我们对位于美国的SCC中1744例连续患者的病历进行了回顾性分析，时间段为转变前四周（2月14日至3月12日）、转变后四周（3月20日至4月16日）以及转变周（3月13日至3月19日）。记录了患者人口统计学信息、支持性护理访视的重要方面，如评估（埃德蒙顿症状评估量表 - 财务和精神状况[ESAS - FS]、减少用量、烦恼、内疚、睁眼筛查 - 改编后纳入药物使用情况[CAGE - AID]以及纪念谵妄评估量表[MDAS]）、跨学科团队参与情况以及访视类型。转变前共诊治763例患者，转变周诊治168例，转变为虚拟护理后诊治813例。三组患者的特征、ESAS - FS、CAGE - AID以及护士评估无显著差异。转变后组的咨询干预与转变前相比略有减少（20.2%对26.2%；P = 0.0068）。转变后MDAS完成率更高（99.6%对98%；P = 0.007）。面对面访视从转变前的100%降至转变后的12.7%（P < 0.0001），虚拟访视增加至49.3%（视频）和38%（电话）。转变后第一周面对面访视降至49%，第二周降至3%，第四周降至<2%（P < 0.0001）。我们的支持性护理团队在数周内从面对面护理转变为虚拟访视，同时保持了高患者量、护理连续性以及对社交距离的遵守。我们的转变可为其他中心提供范例。
