Maitre Nathalie L, Benninger Kristen L, Neel Mary Lauren, Haase Jennifer A, Pietruszewski Lindsay, Levengood Katelyn, Adderley Kathleen, Batterson Nancy, Hague Kaleigh, Lightfoot Megan, Weiss Sarah, Lewandowski Dennis J, Larson Heather
Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Pediatr Qual Saf. 2021 Jul 28;6(4):e439. doi: 10.1097/pq9.0000000000000439. eCollection 2021 Jul-Aug.
Neurodevelopmental surveillance is critical for high-risk infants following neonatal intensive care discharge and is traditionally performed in-person. COVID-19 interruption of regular surveillance necessitated a rapid development of telehealth models for effective and standardized care.
We used implementation science and lean methodologies to develop an effective telehealth neurodevelopmental surveillance program for high-risk infants. Interventions included reorganization of visit flow processes and a telehealth toolkit for standardized neurological and developmental assessments. We tested and improved our intervention through plan-do-study-act cycles, value-added analysis, and parent- and provider-satisfaction questionnaires. Process metrics (standard elements, subspecialty referrals, diagnostic tests, and prescriptions ordered) were compared in group-level analyses between telehealth patients (N = 97) March 16, 2020-July 1, 2020 and a matched in-person cohort at the same period the previous year. Run charts examined shifts in balancing measures (provider efficiency and missed visits) over 8 weeks before and after implementation.
Primary outcomes were visit completion (100%), patient parent satisfaction (>90% strongly agreed or agreed telehealth procedures were valuable and easy to use) and ability to accurately diagnose cerebral palsy (no statistical difference with comparison visits). Providers (N = 6) rated telehealth experiences favorably. Process metrics indicated no differences between telehealth and in-person visits (all .05). Following telehealth implementation, provider efficiency increased to near baseline (median 88.9% versus 91.7%) and median missed visits decreased to 0% from 20% (in-person).
Implementation of telehealth for neurodevelopmental surveillance in a tertiary high-risk infant follow-up clinic successfully provided standardized and timely care during stay-at-home orders; broader telehealth applications may overcome access barriers in this field.
神经发育监测对于新生儿重症监护出院后的高危婴儿至关重要，传统上是面对面进行的。2019冠状病毒病（COVID-19）导致常规监测中断，因此需要迅速开发远程医疗模式，以提供有效和标准化的护理。
我们运用实施科学和精益方法，为高危婴儿开发了一个有效的远程医疗神经发育监测项目。干预措施包括重新组织就诊流程，以及用于标准化神经和发育评估的远程医疗工具包。我们通过计划-执行-研究-行动循环、增值分析以及家长和提供者满意度调查问卷来测试和改进我们的干预措施。在组水平分析中，比较了2020年3月16日至2020年7月1日远程医疗患者（N = 97）与上一年同期匹配的面对面队列的过程指标（标准要素、专科转诊、诊断测试和开具的处方）。运行图检查了实施前后8周内平衡指标（提供者效率和失访）的变化。
主要结果包括就诊完成率（100%）、患者家长满意度（>90%强烈同意或同意远程医疗程序有价值且易于使用）以及准确诊断脑瘫的能力（与对照就诊无统计学差异）。提供者（N = 6）对远程医疗体验给予好评。过程指标表明远程医疗就诊与面对面就诊之间无差异（均P>.05）。实施远程医疗后，提供者效率提高到接近基线水平（中位数88.9%对91.7%），失访中位数从面对面就诊时的20%降至0%。
在三级高危婴儿随访诊所实施远程医疗进行神经发育监测，在居家令期间成功提供了标准化和及时的护理；更广泛的远程医疗应用可能克服该领域的就医障碍。
