一项针对 COVID-19 专科门诊和远程患者监测计划的 360 度混合方法评估。
A 360 degree mixed-methods evaluation of a specialized COVID-19 outpatient clinic and remote patient monitoring program.
机构信息
Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA.
出版信息
BMC Prim Care. 2022 Jun 13;23(1):151. doi: 10.1186/s12875-022-01734-7.
BACKGROUND
Our goals are to quantify the impact on acute care utilization of a specialized COVID-19 clinic with an integrated remote patient monitoring program in an academic medical center and further examine these data with stakeholder perceptions of clinic effectiveness and acceptability.
METHODS
A retrospective cohort was drawn from enrolled and unenrolled ambulatory patients who tested positive in May through September 2020 matched on age, presence of comorbidities and other factors. Qualitative semi-structured interviews with patients, frontline clinician, and administrators were analyzed in an inductive-deductive approach to identify key themes.
RESULTS
Enrolled patients were more likely to be hospitalized than unenrolled patients (N = 11/137 in enrolled vs 2/126 unenrolled, p = .02), reflecting a higher admittance rate following emergency department (ED) events among the enrolled vs unenrolled, though this was not a significant difference (46% vs 25%, respectively, p = .32). Thirty-eight qualitative interviews conducted June to October 2020 revealed broad stakeholder belief in the clinic's support of appropriate care escalation. Contrary to beliefs the clinic reduced inappropriate care utilization, no difference was seen between enrolled and unenrolled patients who presented to the ED and were not admitted (N = 10/137 in enrolled vs 8/126 unenrolled, p = .76). Administrators and providers described the clinic's integral role in allowing health services to resume in other areas of the health system following an initial lockdown.
CONCLUSIONS
Acute care utilization and multi-stakeholder interviews suggest heightened outpatient observation through a specialized COVID-19 clinic and remote patient monitoring program may have contributed to an increase in appropriate acute care utilization. The clinic's role securing safe reopening of health services systemwide was endorsed as a primary, if unmeasured, benefit.
背景
我们的目标是量化一个学术医疗中心的 COVID-19 专科诊所与远程患者监测项目相结合对急性护理利用的影响，并进一步通过利益相关者对诊所有效性和可接受性的看法来检查这些数据。
方法
从 2020 年 5 月至 9 月期间在门诊检测呈阳性的已登记和未登记患者中抽取了一个回顾性队列，按年龄、合并症的存在和其他因素进行匹配。对患者、一线临床医生和管理人员进行了定性半结构化访谈，采用归纳演绎方法分析确定关键主题。
结果
已登记患者比未登记患者更有可能住院（登记组 11/137 例 vs 未登记组 2/126 例，p=0.02），这反映了登记组患者在急诊科事件后住院率更高，尽管这并不是显著差异（分别为 46%和 25%，p=0.32）。2020 年 6 月至 10 月期间进行的 38 次定性访谈显示，广泛的利益相关者认为该诊所支持适当的护理升级。尽管人们认为该诊所减少了不适当的护理利用，但在未住院的急诊科就诊患者中，登记组和未登记组之间没有差异（登记组 10/137 例 vs 未登记组 8/126 例，p=0.76）。管理人员和提供者描述了该诊所的重要作用，该诊所允许卫生系统在最初封锁后在其他卫生系统领域恢复服务。
结论
急性护理的利用和多利益相关者访谈表明，通过专门的 COVID-19 诊所和远程患者监测项目加强门诊观察可能有助于适当的急性护理利用增加。该诊所在确保整个卫生服务系统安全重新开放方面的作用被认为是一个主要的（即使没有测量到的）好处。
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