Haque Saira Naim, DeStefano Sydney, Banger Alison, Rutledge Regina, Romaire Melissa
RTI International, Research Triangle Park, NC, United States.
JMIR Form Res. 2021 May 5;5(5):e24118. doi: 10.2196/24118.
Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration.
The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States.
This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services-funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes.
Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors.
Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing.
远程医疗有潜力帮助农村地区的个人克服地理障碍，并改善医疗服务的可及性。影响急救医院远程医疗实施和使用的因素有待探索。
本研究的目的是了解影响美国一组前沿急救医院远程医疗采用和使用的因素。
这项工作是对医疗保险和医疗补助服务中心资助的一个示范项目进行更大规模评估的一部分，该项目旨在扩大对前沿急救医院医疗保险受益人的服务按成本报销。我们的样本是蒙大拿州、内华达州和北达科他州的8家实施该示范项目远程医疗部分的急救医院。我们审查了示范项目的申请和进展报告，并进行了实地考察。我们使用半结构化讨论指南促进与临床、行政和信息技术人员的对话。使用NVivo软件（QSR国际公司），我们对访谈记录进行编码，然后分析主题。
几个因素影响了急救医院远程医疗的实施和使用，包括工作流程和基础设施的改变以及从业者的接受程度和可用性。参与者还提到技术援助和实施支持是有利因素。
前沿急救医院可能采用远程医疗来克服诸如与专科医生距离远和劳动力方面的挑战等问题。远程医疗可用于提供者与患者以及提供者与提供者之间的互动，以改善医疗服务的可及性、消除障碍并提高质量。然而，远程医疗改善治疗效果的能力受到工作流程和基础设施变化、从业者接受程度和可用性以及资金等因素的限制。
