Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts; and
Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.
Pediatrics. 2021 Jul;148(1). doi: 10.1542/peds.2020-030494. Epub 2021 Feb 25.
The coronavirus pandemic created significant, abrupt challenges to the delivery of ambulatory health care. Because tertiary medical centers limited elective in-person services, telehealth was rapidly enacted in settings with minimal previous experience to allow continued access to care. With this quality improvement (QI) initiative, we aimed to achieve a virtual visit volume of at least 75% of our prepandemic volume. We also describe patient and provider experience with telehealth services.
Our QI team identified the primary drivers contributing to low telehealth volume and developed a telehealth scheduling protocol and data tracking system using QI-based strategies. Patients and providers were surveyed on their telehealth experience.
At the onset of the pandemic, weekly visit volume dropped by 65% (99 weekly visits; historical average of 281). Over the subsequent 3 weeks, using rapid Plan-Do-Study-Act cycles, we achieved our goal volume. In surveys, it was indicated that most participants had never before used telehealth (71% of patients; 82% of providers) yet reported high satisfaction (90% of patients; 81% of providers). Both groups expressed concern over the lack of in-person assessments. Most respondents were interested in future use of telehealth.
With a QI-based approach, we successfully maintained access to care via telehealth services for pediatric pulmonary patients during the coronavirus pandemic and found high rates of satisfaction among patients and providers. Telehealth will likely continue to be a part of our health care delivery platform, expanding the reach of our services. Further work is needed to understand the effects on clinical outcomes.
冠状病毒大流行给门诊医疗服务的提供带来了巨大的、突然的挑战。由于三级医疗中心限制了非紧急的面对面服务，因此在以前几乎没有经验的情况下迅速采用了远程医疗，以使患者能够继续获得医疗服务。通过这一质量改进（QI）计划，我们的目标是实现至少 75%的虚拟就诊量，达到大流行前的水平。我们还描述了患者和医务人员对远程医疗服务的体验。
我们的 QI 团队确定了导致远程医疗量低的主要驱动因素，并开发了远程医疗预约协议和数据跟踪系统，使用基于 QI 的策略。对患者和医务人员进行了远程医疗体验调查。
在大流行开始时，每周就诊量下降了 65%（99 次就诊；历史平均就诊量为 281 次）。在随后的 3 周内，通过快速的计划-实施-研究-行动循环，我们达到了预期的就诊量。在调查中，大多数参与者表示他们以前从未使用过远程医疗（71%的患者；82%的医务人员），但报告满意度很高（90%的患者；81%的医务人员）。两组人员都对缺乏面对面评估表示担忧。大多数受访者有兴趣在未来使用远程医疗。
通过基于 QI 的方法，我们成功地在冠状病毒大流行期间为儿科肺病患者维持了通过远程医疗服务获得医疗服务的机会，并发现患者和医务人员的满意度都很高。远程医疗很可能继续成为我们医疗服务提供平台的一部分，扩大我们服务的覆盖范围。需要进一步研究了解其对临床结果的影响。
