Mines Saint-Etienne, Univ Clermont Auvergne, CNRS, UMR 6158 LIMOS, Centre CIS, F-42023 Saint-Étienne, France.
Groupe mutualiste Aesio, F-42100 Saint-Étienne, France.
J Med Internet Res. 2022 May 20;24(5):e32002. doi: 10.2196/32002.
In recent years, the rapid development of information and communications technology enabled by innovations in videoconferencing solutions and the emergence of connected medical devices has contributed to expanding the scope of application and expediting the development of telemedicine.
This study evaluates the use of teleconsultations (TCs) for specialist consultations at hospitals in terms of costs, resource consumption, and patient travel time. The key feature of our evaluation framework is the combination of an economic evaluation through a cost analysis and a performance evaluation through a discrete-event simulation (DES) approach.
Three data sets were used to obtain detailed information on the characteristics of patients, characteristics of patients' residential locations, and usage of telehealth stations. A total of 532 patients who received at least one TC and 18,559 patients who received solely physical consultations (CSs) were included in the initial sample. The TC patients were recruited during a 7-month period (ie, 2020 data) versus 19 months for the CS patients (ie, 2019 and 2020 data). A propensity score matching procedure was applied in the economic evaluation. To identify the best scenarios for reaping the full benefits of TCs, various scenarios depicting different population types and deployment strategies were explored in the DES model. Associated break-even levels were calculated.
The results of the cost evaluation reveal a higher cost for the TC group, mainly induced by higher volumes of (tele)consultations per patient and the substantial initial investment required for TC equipment. On average, the total cost per patient over 298 days of follow-up was €356.37 (US $392) per TC patient and €305.18 (US $336) per CS patient. However, the incremental cost of TCs was not statistically significant: €356.37 - €305.18 = €51.19 or US $392 - US $336 = US $56 (95% CI -35.99 to 114.25; P=.18). Sensitivity analysis suggested heterogeneous economic profitability levels within subpopulations and based on the intensity of use of TC solutions. In fact, the DES model results show that TCs could be a cost-saving strategy in some cases, depending on population characteristics, the amortization speed of telehealth equipment, and the locations of telehealth stations.
The use of TCs has the potential to lead to a major organizational change in the health care system in the near future. Nevertheless, TC performance is strongly related to the context and deployment strategy involved.
近年来，视频会议解决方案的创新和联网医疗设备的出现推动了信息和通信技术的快速发展，这扩大了远程医疗的应用范围并加速了其发展。
本研究从成本、资源消耗和患者出行时间方面评估了医院的远程咨询（TC）在专科会诊中的应用。我们的评估框架的主要特点是通过成本分析进行经济评估和通过离散事件模拟（DES）方法进行绩效评估相结合。
使用三个数据集来获取有关患者特征、患者居住地点特征以及远程医疗站使用情况的详细信息。共有 532 名接受至少一次 TC 的患者和 18559 名仅接受物理咨询（CS）的患者被纳入初始样本。TC 患者的招募时间为 7 个月（即 2020 年数据），而 CS 患者的招募时间为 19 个月（即 2019 年和 2020 年数据）。在经济评估中应用了倾向评分匹配程序。为了确定充分利用 TC 全部效益的最佳方案，在 DES 模型中探索了不同的人口类型和部署策略的各种方案。计算了相关的盈亏平衡水平。
成本评估结果显示 TC 组的成本更高，主要是由于每位患者的（远程）咨询量较高，以及 TC 设备的初始投资较大。平均而言，298 天随访期间每位患者的总成本为 TC 患者 356.37 欧元（392 美元），CS 患者 305.18 欧元（336 美元）。然而，TC 的增量成本并不具有统计学意义：356.37 欧元-305.18 欧元= 51.19 欧元或 392 美元-336 美元= 56 美元（95%CI-35.99 至 114.25；P=.18）。敏感性分析表明，在亚人群中以及根据 TC 解决方案的使用强度，存在不同的经济盈利水平。事实上，DES 模型的结果表明，在某些情况下，TC 可以成为一种节省成本的策略，具体取决于人口特征、远程医疗设备的摊销速度和远程医疗站的位置。
远程咨询的使用有可能在不久的将来在医疗保健系统中引发重大的组织变革。然而，TC 的性能与所涉及的环境和部署策略密切相关。
