National Clinician Scholars Program, University of Michigan, Ann Arbor.
Veterans Affairs Ann Arbor, Ann Arbor, Michigan.
JAMA Surg. 2021 Jul 1;156(7):620-626. doi: 10.1001/jamasurg.2021.0979.
While telehealth use in surgery has shown to be feasible, telehealth became a major modality of health care delivery during the COVID-19 pandemic.
To assess patterns of telehealth use across surgical specialties before and during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: Insurance claims from a Michigan statewide commercial payer for new patient visits with a surgeon from 1 of 9 surgical specialties during one of the following periods: prior to the COVID-19 pandemic (period 1: January 5 to March 7, 2020), early pandemic (period 2: March 8 to June 6, 2020), and late pandemic (period 3: June 7 to September 5, 2020).
Telehealth implementation owing to the COVID-19 pandemic in March 2020.
(1) Conversion rate defined as the rate of weekly new patient telehealth visits divided by mean weekly number of total new patient visits in 2019. This outcome adjusts for a substantial decrease in outpatient care during the pandemic. (2) Weekly number of new patient telehealth visits divided by weekly number of total new patient visits.
Among 4405 surgeons in the cohort, 2588 (58.8%) performed telehealth in any patient care context. Specifically for new patient visits, 1182 surgeons (26.8%) used telehealth. A total of 109 610 surgical new outpatient visits were identified during the pandemic. The median (interquartile range) age of telehealth patients was 46.8 (34.1-58.4) years compared with 52.6 (38.3-62.3) years for patients who received care in-person. Prior to March 2020, less than 1% (8 of 173 939) of new patient visits were conducted through telehealth. Telehealth use peaked in April 2020 (week 14) and facilitated 34.6% (479 of 1383) of all new patient visits during that week. The telehealth conversion rate peaked in April 2020 (week 15) and was equal to 8.2% of the 2019 mean weekly new patient visit volume. During period 2, a mean (SD) of 16.6% (12.0%) of all new patient surgical visits were conducted via telehealth (conversion rate of 5.1% of 2019 mean weekly new patient visit volumes). During period 3, 3.0% (2168 of 71 819) of all new patient surgical visits were conducted via telehealth (conversion rate of 2.5% of 2019 new patient visit volumes). Mean (SD) telehealth conversion rates varied by specialty with urology being the highest (14.3% [7.7%]).
Results from this study showed that telehealth use grew across all surgical specialties in Michigan in response to the COVID-19 pandemic. While rates of telehealth use have declined as in-person care has resumed, telehealth use remains substantially higher across all surgical specialties than it was prior to the pandemic.
虽然远程医疗在外科领域的应用已经被证明是可行的，但在 COVID-19 大流行期间，远程医疗成为医疗保健服务的主要模式。
评估 COVID-19 大流行前后各外科专业远程医疗使用的模式。
设计、地点和参与者：从密歇根州一家全州性商业支付者的保险索赔中，获取了 9 个外科专业中任何一个专业的新患者就诊记录，这些记录是在以下三个时期之一的新患者就诊记录：在 COVID-19 大流行之前（第 1 期：2020 年 1 月 5 日至 3 月 7 日）、大流行早期（第 2 期：2020 年 3 月 8 日至 6 月 6 日）和大流行后期（第 3 期：2020 年 6 月 7 日至 9 月 5 日）。
2020 年 3 月 COVID-19 大流行期间实施远程医疗。
（1）转换率定义为每周新患者远程医疗就诊次数与 2019 年每周新患者总就诊次数的比率。该结果调整了大流行期间门诊护理的大幅下降。（2）每周新患者远程医疗就诊次数与每周新患者总就诊次数的比值。
在队列中的 4405 名外科医生中，有 2588 名（58.8%）在任何患者护理环境中实施了远程医疗。具体来说，在新患者就诊中，有 1182 名外科医生（26.8%）使用了远程医疗。在大流行期间共确定了 109610 例外科新门诊就诊。远程医疗患者的中位数（四分位距）年龄为 46.8（34.1-58.4）岁，而接受面对面护理的患者年龄为 52.6（38.3-62.3）岁。在 2020 年 3 月之前，不到 1%（173939 例中的 8 例）的新患者就诊是通过远程医疗进行的。远程医疗的使用在 2020 年 4 月达到峰值（第 14 周），在该周所有新患者就诊中占 34.6%（1383 例中的 479 例）。远程医疗转换率在 2020 年 4 月达到峰值（第 15 周），等于 2019 年每周新患者就诊量的 8.2%。在第 2 期，平均（SD）16.6%（12.0%）的所有新患者外科就诊通过远程医疗进行（转换率为 2019 年每周新患者就诊量的 5.1%）。在第 3 期，所有新患者外科就诊中，有 3.0%（71819 例中的 2168 例）通过远程医疗进行（转换率为 2019 年新患者就诊量的 2.5%）。平均（SD）远程医疗转换率因专业而异，泌尿科最高（14.3%[7.7%]）。
这项研究的结果表明，密歇根州所有外科专业的远程医疗使用量都有所增加，以应对 COVID-19 大流行。虽然随着面对面护理的恢复，远程医疗的使用率有所下降，但与大流行前相比，所有外科专业的远程医疗使用量仍然大大增加。
