Loncharich Michael F, Desena David F, Collamer Angelique N, Edison Jess D
Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Mil Med. 2023 Jul 22;188(7-8). doi: 10.1093/milmed/usab531. Epub 2021 Dec 28.
To compare patterns of rheumatology consultations and outcomes across four different platforms in the Military Health System (MHS): face-to-face, synchronous telehealth, and two asynchronous telehealth platforms.
We conducted a retrospective review comparing face-to-face rheumatology consults during 2019 with teleconsultations from three virtual systems in the MHS: an asynchronous email-based system from May 2006 to Feb 2018, a web-based platform from 2014 to 2018, and synchronous telehealth consults from March 2020 to March 2021. Consults were reviewed for diagnosis, and if medical evacuation was required for consults originating OCONUS or if face-to-face follow-up was required for synchronous teleconsults. Diagnoses of interest included inflammatory arthritis, noninflammatory arthritis, crystalline arthritis, myositis, lupus, vasculitis, fibromyalgia, antibody positivity without diagnosis, symptoms without specified diagnosis, and a composite of other rheumatic diseases.
Leading diagnoses across platforms were inflammatory arthritis, noninflammatory arthritis, and a composite of other diagnoses. Consultation modality influenced the type of cases seen. Inflammatory arthritis accounted for significantly more consults in the synchronous telehealth (38.4%) and email-based (40.9%) models than in the web-based (23.7%) and face-to-face (32.0%) models. The composite of other diagnoses was the leading diagnosis for the asynchronous web-based model (32.9%), which was significantly more than the synchronous telehealth and face-to-face consults. Synchronous models saw significantly more cases of crystalline arthritis, vasculitis, and fibromyalgia.Email-based consultations resulted in medical evacuation in 25 cases and prevented evacuation in 5. Web-based consultations prompted medical evacuation in 100 cases. In the synchronous model, face-to-face follow-up was recommended in 142 (15%) cases.
Modality of consultation influences the type of cases seen. Both synchronous and asynchronous telerheumatology models were able to answer the consult question without referral for face-to-face evaluation in 79.9-85.0% of consults, suggesting teleconsultation is a viable method to increase access to high-quality rheumatology care.
比较军事卫生系统（MHS）中四个不同平台的风湿病会诊模式及结果，这四个平台分别是：面对面会诊、同步远程医疗以及两个异步远程医疗平台。
我们进行了一项回顾性研究，将2019年的面对面风湿病会诊与MHS中三个虚拟系统的远程会诊进行比较，这三个虚拟系统分别是：2006年5月至2018年2月的基于电子邮件的异步系统、2014年至2018年的基于网络的平台以及2020年3月至2021年3月的同步远程医疗会诊。对会诊的诊断情况进行审查，对于来自美国境外（OCONUS）的会诊是否需要医疗后送，或者同步远程会诊是否需要面对面随访。感兴趣的诊断包括炎性关节炎、非炎性关节炎、晶体性关节炎、肌炎、狼疮、血管炎、纤维肌痛、未确诊的抗体阳性、未明确诊断的症状以及其他风湿性疾病的综合情况。
各平台的主要诊断为炎性关节炎、非炎性关节炎以及其他诊断的综合情况。会诊方式影响了所见到的病例类型。与基于网络的（23.7%）和面对面的（32.0%）模式相比，炎性关节炎在同步远程医疗（38.4%）和基于电子邮件的（40.9%）模式中的会诊占比显著更高。其他诊断的综合情况是基于网络的异步模式的主要诊断（32.9%），显著高于同步远程医疗和面对面会诊。同步模式中晶体性关节炎、血管炎和纤维肌痛的病例显著更多。基于电子邮件的会诊导致25例进行了医疗后送，5例避免了后送。基于网络的会诊促使100例进行了医疗后送。在同步模式中，142例（15%）建议进行面对面随访。
会诊方式影响所见到的病例类型。同步和异步远程风湿病学模式在79.9% - 85.0%的会诊中能够在不转诊进行面对面评估的情况下回答会诊问题，这表明远程会诊是增加获得高质量风湿病护理机会的可行方法。
