Leyenaar JoAnna K, McDaniel Corrie E, Arthur Kimberly C, Stevens Cathryn A, St Ivany Amanda R
Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, N.H.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, N.H.
Pediatr Qual Saf. 2021 Sep 24;6(5):e476. doi: 10.1097/pq9.0000000000000476. eCollection 2021 Sep-Oct.
The coronavirus disease 2019 (COVID-19) pandemic incited substantial changes to acute care delivery, including the rapid scale-up of telehealth and numerous changes to in-person care. This study explored health system changes associated with the COVID-19 pandemic and their influences on pediatric acute care delivery and quality of care.
We conducted 38 semistructured interviews May-November 2020 with families and clinicians from 3 US regions, eliciting their perspectives and experiences regarding changes to acute care delivery during the pandemic. Interviews were analyzed using a general inductive approach to identify relationships between clinical care infrastructure, care processes, and healthcare quality.
Emerging knowledge of COVID-19 epidemiology and associated restrictions influenced care-seeking behaviors and clinical infrastructure and processes. Infrastructure changes included the closure of some clinics, limited "sick visit" hours and locations, and increased resources for telehealth. Modified care processes included the assignment of clinicians to specific roles, limitations on sibling attendance, increased referrals to other clinics, and iterative development of procedures and protocols. Although intended to increase safety, these changes appear to have decreased access, timeliness, and equity of care. High-quality care was supported by telephone triage processes, in-person visits following initial assessments by telehealth, and identification of diagnoses and populations best-suited to telehealth versus in-person care.
Changes in acute care delivery during the COVID-19 pandemic may have negatively impacted healthcare quality in some domains. Implementation of pediatric-specific guidelines and decision aids describing diagnoses, populations, and procedures best-suited to telehealth may improve the quality of acute care delivery.
2019年冠状病毒病（COVID-19）大流行引发了急性护理服务的重大变化，包括远程医疗的迅速扩大以及面对面护理的诸多改变。本研究探讨了与COVID-19大流行相关的卫生系统变化及其对儿科急性护理服务和护理质量的影响。
2020年5月至11月，我们对来自美国3个地区的家庭和临床医生进行了38次半结构化访谈，了解他们对大流行期间急性护理服务变化的看法和经历。采用一般归纳法对访谈进行分析，以确定临床护理基础设施、护理流程和医疗质量之间的关系。
对COVID-19流行病学的新认识及相关限制影响了求医行为、临床基础设施和流程。基础设施变化包括一些诊所关闭、“看病”时间和地点受限以及远程医疗资源增加。修改后的护理流程包括为临床医生分配特定角色、限制兄弟姐妹陪同、增加转介到其他诊所以及程序和协议的迭代制定。尽管这些变化旨在提高安全性，但似乎减少了医疗服务的可及性、及时性和公平性。电话分诊流程、远程医疗初步评估后的面对面就诊以及确定最适合远程医疗与面对面护理的诊断和人群，为高质量护理提供了支持。
COVID-19大流行期间急性护理服务的变化可能在某些领域对医疗质量产生了负面影响。实施针对儿科的指南和决策辅助工具，描述最适合远程医疗的诊断、人群和程序，可能会提高急性护理服务的质量。
