将四重目标应用于评估远程医疗计划的运营影响。
Application of the Quadruple Aim to evaluate the operational impact of a telemedicine program.
机构信息
Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.
Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA.
出版信息
Healthc (Amst). 2021 Dec;9(4):100593. doi: 10.1016/j.hjdsi.2021.100593. Epub 2021 Nov 5.
BACKGROUND
In response to the COVID-19 pandemic, telemedicine utilization has increased dramatically, yet most institutions lack a standardized approach to determine how much to invest in these programs.
METHODS
We used the Quadruple Aim to evaluate the operational impact of CardioClick, a program replacing in-person follow-up visits with video visits in a preventive cardiology clinic. We examined data for 134 patients enrolled in CardioClick with 181 video follow-up visits and 276 patients enrolled in the clinic's traditional prevention program with 694 in-person follow-up visits.
RESULTS
Patients in CardioClick and the cohort receiving in-person care were similar in terms of age (43 vs 45 years), gender balance (74% vs 79% male), and baseline clinical characteristics. Video follow-up visits were shorter than in-person visits in terms of clinician time (median 22 vs 30 min) and total clinic time (median 22 vs 68 min). Video visits were more likely to end on time than in-person visits (71 vs 11%, p < .001). Physicians more often completed video visit documentation on the day of the visit (56 vs 42%, p = .002).
CONCLUSIONS
Implementation of video follow-up visits in a preventive cardiology clinic was associated with operational improvements in the areas of efficiency, patient experience, and clinician experience. These benefits in three domains of the Quadruple Aim justify expanded use of telemedicine at our institution.
IMPLICATIONS
The Quadruple Aim provides a framework to evaluate telemedicine programs recently implemented in many health systems.
LEVEL OF EVIDENCE
Level III (retrospective comparative study).
背景
为应对 COVID-19 大流行，远程医疗的使用量大幅增加，但大多数机构缺乏标准化的方法来确定在这些项目上投资多少。
方法
我们使用四重目标来评估 CardioClick 计划对预防心脏病学诊所的运营影响，该计划用视频就诊取代了面对面的随访。我们检查了 134 名参与 CardioClick 计划的患者（181 次视频随访）和 276 名参与诊所传统预防计划的患者（694 次面对面随访）的数据。
结果
CardioClick 计划中的患者和接受面对面护理的患者在年龄（43 岁对 45 岁）、性别平衡（74%对 79%男性）和基线临床特征方面相似。与面对面就诊相比，视频随访在医生时间（中位数 22 分钟对 30 分钟）和总就诊时间（中位数 22 分钟对 68 分钟）方面更短。视频就诊更有可能按时结束（71%对 11%，p < 0.001）。医生更经常在就诊当天完成视频就诊记录（56%对 42%，p = 0.002）。
结论
在预防心脏病学诊所实施视频随访与提高效率、患者体验和临床医生体验等方面的运营改善相关。四重目标这三个领域的收益证明了我们机构扩大使用远程医疗的合理性。
意义
四重目标为评估最近在许多医疗系统中实施的远程医疗计划提供了一个框架。
证据水平
三级（回顾性比较研究）。
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