University of Illinois at Chicago, Chicago, IL, United States of America.
University of Illinois at Chicago, Chicago, IL, United States of America.
J Pediatr Nurs. 2021 Jul-Aug;59:143-150. doi: 10.1016/j.pedn.2021.04.005. Epub 2021 Apr 19.
BACKGROUND/PROBLEM: Failed patient care appointments (no-shows) can lead to negative patient health outcomes and increased healthcare costs. There is evidence that telehealth is a safe, effective, and a cost-efficient option for those unable to attend in-person visits. No-show rates in pediatrics are unique due to reliance on caregivers to attend appointments. A pediatric asthma mobile van, which provides specialty care to children at schools in low-income communities in Chicago, was experiencing a high no-show rate.
METHODS/INTERVENTIONS: Building on evidence that the use of telehealth technology improves access to care, the purpose of this quality improvement initiative was to implement a new telehealth option for off-site parents to attend their child's on-site appointment. The designed initiative followed the Plan-Do-Study-Act model with three small phases of change. The first phase assessed telehealth interest using a Likert-scale questionnaire. The second phase designed and implemented a telehealth option and collected no-show rates pre- and post- implementation. The final phase assessed parental satisfaction using a Telehealth Usability Questionnaire.
Over 50% of participants stated interest in the parent off-site telehealth option for their child's appointment. No-show rates decreased from 36% to 7.9%-18% per month over a 10-month implementation period. Post-telehealth surveys completed by parents revealed this version of telehealth improved access to care for their child, saved them time, and was simple to use.
No-show rates decreased after successful implementation of an innovative approach to telehealth. This parent off-site telehealth model can be another approach toward increasing pediatric healthcare access.
背景/问题：患者预约失约（爽约）可能导致患者健康状况恶化和医疗成本增加。有证据表明，对于无法亲自就诊的患者，远程医疗是一种安全、有效且具有成本效益的选择。儿科的爽约率是独特的，因为依赖照顾者来参加预约。一辆儿科哮喘流动车为芝加哥低收入社区的学校的儿童提供专业护理，该流动车的爽约率很高。
方法/干预措施：基于使用远程医疗技术可改善医疗服务可及性的证据，本质量改进计划的目的是为不在现场的家长实施一种新的远程医疗选择，以便参加其子女的现场预约。该计划遵循计划-执行-研究-行动模型，分为三个小的变更阶段。第一阶段使用李克特量表问卷评估远程医疗的兴趣。第二阶段设计并实施了远程医疗选项，并在实施前后收集了爽约率。最后一个阶段使用远程医疗可用性问卷评估了家长的满意度。
超过 50%的参与者表示对其子女预约的家长远程医疗选项感兴趣。在 10 个月的实施期间，爽约率从 36%降至 7.9%-18%/月。家长在远程医疗实施后完成的调查显示，这种远程医疗版本改善了他们孩子的医疗服务可及性，为他们节省了时间，并且易于使用。
成功实施创新的远程医疗方法后，爽约率下降。这种家长远程医疗模式可以成为增加儿科医疗服务可及性的另一种方法。
