Howie Flora, Kreofsky Beth L, Ravi Anupama, Lokken Troy, Hoff Mekenzie D, Fang Jennifer L
Division of Developmental and Behavioral Pediatrics, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Telemed J E Health. 2022 Jan;28(1):3-10. doi: 10.1089/tmj.2020.0562. Epub 2021 May 17.
Background:Before the COVID-19 pandemic, telemedicine use for outpatient pediatric specialty care was low. Stay-at-home orders (SHO) prompted rapid upscaling of telemedicine capabilities and upskilling of providers. This study compares telemedicine usage before and after the SHO and analyzes how a Children's Center addressed challenges associated with a rapid rise in telemedicine.
Methods:Data on outpatient visits across 14 specialty divisions were abstracted from the institutional electronic medical record. The 12-week study period (March 9, 2020-May 29, 2020) spanned three epochs: pre-SHO; post-SHO; reopening to in-person visits. Changes in in-person visits, video visits, and completed, cancelled, and no-show appointments were compared between three epochs.
Results:A total of 4,914 outpatient pediatric specialty visits were completed, including 67% (3,296/4,914) in-person and 33% (1,618/4,914) through video. During the first two epochs encompassing the SHO, video visits increased by 4,750%. During the third epoch when the SHO was lifted, video visits decreased by 66%, with 19.4% of visits conducted through video in week 12. Overall, for outpatient video appointments, 82.8% (1,618/1,954) were completed, 9.1% (178/1,954) were cancelled, and 8.1% (158/1,954) were no-shows. The percentage of completed and no-show appointments did not differ between epochs. However, the cancellation rate decreased significantly from Epochs 1 to 3 (p = 0.008).
Conclusion:A SHO was associated with a large increase in pediatric specialty video visits. Post-SHO, the percentage of pediatric specialty visits conducted through video decreased but remained higher than before the SHO. Frequent, content-rich communications, self-directed tutorials, and individualized coaching may facilitate successful increases in telemedicine use.
在新型冠状病毒肺炎疫情之前，门诊儿科专科护理中远程医疗的使用率较低。居家令促使远程医疗能力迅速提升，医疗服务提供者的技能也得到提高。本研究比较了居家令前后远程医疗的使用情况，并分析了一家儿童中心如何应对与远程医疗快速增长相关的挑战。
从机构电子病历中提取了14个专科部门的门诊就诊数据。为期12周的研究期（2020年3月9日至2020年5月29日）跨越三个阶段：居家令前；居家令后；重新恢复面对面就诊。比较了三个阶段之间面对面就诊、视频就诊以及已完成、取消和爽约预约的变化情况。
共完成了4914次门诊儿科专科就诊，其中67%（3296/4914）为面对面就诊，33%（1618/4914）为视频就诊。在包含居家令的前两个阶段，视频就诊增加了4750%。在居家令解除后的第三个阶段，视频就诊减少了66%，在第12周有19.4%的就诊是通过视频进行的。总体而言，对于门诊视频预约，82.8%（1618/1954）已完成，9.1%（178/1954）被取消，8.1%（158/1954）爽约。已完成预约和爽约预约的百分比在各阶段之间没有差异。然而，取消率从第1阶段到第3阶段显著下降（p = 0.008）。
居家令与儿科专科视频就诊的大幅增加有关。居家令后，通过视频进行的儿科专科就诊百分比下降，但仍高于居家令之前。频繁、内容丰富的沟通、自主学习教程和个性化辅导可能有助于成功增加远程医疗的使用。
