Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH.
JCO Oncol Pract. 2022 Jul;18(7):e1141-e1153. doi: 10.1200/OP.21.00750. Epub 2022 Apr 21.
To characterize the use of telemedicine for oncology care over the course of the COVID-19 pandemic in Northern New England with a focus on factors affecting trends.
We performed a retrospective observational study using patient visit data from electronic health records from hematology-oncology and radiation-oncology service lines spanning the local onset of the pandemic from March 18, 2020, through March 31, 2021. This period was subdivided into four phases designated as lockdown, transition, stabilization, and second wave. Generalized linear mixed regression models were used to estimate the effects of patient characteristics on trends for rates of telemedicine use across phases and the effects of visit type on patient satisfaction and postvisit ER or hospital admissions within 2 weeks.
A total of 19,280 patients with 102,349 visits (13.1% audio-only and 1.4% video) were studied. Patient age (increased use in age < 45 and 85 years and older) and urban residence were associated with higher use of telemedicine, especially after initial lockdown. Recent cancer therapy, ER use, and hospital admissions in the past year were all associated with lower telemedicine utilization across pandemic phases. Provider clinical department corresponded to the largest differences in telemedicine use across all phases. ER and hospital admission rates in the 2 weeks after a telehealth visit were lower than those in in-person visits (0.7% 1.3% and 1.2% 2.7% for ER and hospital use, respectively; < .001). Patient satisfaction did not vary across visit types.
Telemedicine use in oncology during the COVID-19 pandemic varied according to the phase and patient, medical, and health system factors, suggesting opportunities for standardization of care and need for attention to equitable telemedicine access.
以影响趋势的因素为重点，描述 COVID-19 大流行期间新英格兰北部肿瘤学护理中远程医疗的使用情况。
我们使用电子病历中的患者就诊数据进行了一项回顾性观察研究，这些数据来自血液肿瘤科和放射肿瘤科服务线，涵盖了 2020 年 3 月 18 日至 2021 年 3 月 31 日当地大流行的开始。这一时期分为四个阶段，分别为封锁、过渡、稳定和第二波。使用广义线性混合回归模型来估计患者特征对各阶段远程医疗使用率趋势的影响，以及就诊类型对 2 周内患者满意度和就诊后急诊或住院的影响。
共纳入 19280 例患者的 102349 次就诊（13.1%为音频就诊，1.4%为视频就诊）。患者年龄（<45 岁和 85 岁以上年龄组使用远程医疗的比例较高）和城市居住与远程医疗使用率较高有关，尤其是在最初的封锁之后。最近的癌症治疗、急诊就诊和过去一年的住院与整个大流行期间远程医疗使用率较低有关。临床科室与所有阶段远程医疗使用率的差异最大。远程医疗就诊后 2 周内急诊就诊和住院的发生率低于门诊就诊（急诊就诊分别为 0.7%和 1.3%，住院就诊分别为 1.2%和 2.7%；<0.001）。患者满意度在就诊类型之间没有差异。
COVID-19 大流行期间肿瘤学中远程医疗的使用因阶段和患者、医疗和卫生系统因素而异，这表明有机会对护理进行标准化，并需要关注公平获得远程医疗的机会。
