远程医疗在小儿外科中的应用对环境的影响。
Environmental impact of telehealth use for pediatric surgery.
机构信息
Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
出版信息
J Pediatr Surg. 2022 Dec;57(12):865-869. doi: 10.1016/j.jpedsurg.2022.06.023. Epub 2022 Jul 7.
BACKGROUND
The healthcare sector is responsible for 10% of US greenhouse gas emissions. Telehealth use may decrease healthcare's carbon footprint. Our institution introduced telehealth to support SARS-CoV-2 social distancing. We aimed to evaluate the environmental impact of telehealth rollout.
METHODS
We conducted a retrospective cohort study of pediatric patients seen by a surgical or pre anesthesia provider between March 1, 2020 and March 1, 2021. We measured patient-miles saved and CO emissions prevented to quantify the environmental impact of telehealth. Miles saved were calculated by geodesic distance between patient home address and our institution. Emissions prevented were calculated assuming 25 miles per gallon fuel efficiency and 19.4 pounds of CO produced per gallon of gasoline consumed. Unadjusted Poisson regression was used to assess relationships between patient demographics, geography, and telehealth use.
RESULTS
60,773 in-person and 10,626 telehealth encounters were included. This represented an 8,755% increase in telehealth use compared to the year prior. Telehealth resulted in 887,006 patient-miles saved and 688,317 fewer pounds of CO emitted. Demographics significantly associated with decreased telehealth use included Asian and Black/African American racial identity, Hispanic ethnic identity, and primary language other than English. Further distance from the hospital and higher area deprivation index were associated with increased telehealth use (IRR 1.0006 and 1.0077, respectively).
CONCLUSION
Incorporating telehealth into pediatric surgical and pre anesthesia clinics resulted in significant CO emission reductions. Expanded telehealth use could mitigate surgical and anesthesia service contributions to climate change. Racial and linguistic minority status were associated with significantly lower rates of telehealth utilization, necessitating additional inquiry into equitable telemedicine use for minoritized populations.
LEVEL OF EVIDENCE
Level IV.
背景
医疗保健部门占美国温室气体排放量的 10%。远程医疗的使用可能会减少医疗保健的碳足迹。我们的机构引入远程医疗是为了支持 SARS-CoV-2 的社交距离。我们旨在评估远程医疗推出的环境影响。
方法
我们对 2020 年 3 月 1 日至 2021 年 3 月 1 日期间由外科或麻醉前提供者就诊的儿科患者进行了回顾性队列研究。我们测量了节省的患者里程数和防止的 CO 排放量，以量化远程医疗的环境影响。节省的里程数是通过患者家庭住址和我们机构之间的大地测量距离计算得出的。假设每加仑燃料行驶 25 英里，每加仑汽油消耗产生 19.4 磅 CO，从而计算出防止的排放量。使用未调整的 Poisson 回归来评估患者人口统计学、地理位置和远程医疗使用之间的关系。
结果
包括 60773 次面对面和 10626 次远程医疗就诊。与前一年相比，远程医疗的使用增加了 8755%。远程医疗节省了 887006 英里的患者里程数，减少了 688317 磅的 CO 排放量。与远程医疗使用减少显著相关的人口统计学因素包括亚洲和非裔美国人的种族身份、西班牙裔民族身份以及非英语的主要语言。与远程医疗使用增加显著相关的是离医院更远的距离和更高的区域贫困指数（IRR 分别为 1.0006 和 1.0077）。
结论
将远程医疗纳入儿科外科和麻醉前诊所导致 CO 排放量显著减少。扩大远程医疗的使用可以减轻手术和麻醉服务对气候变化的贡献。少数族裔和语言少数群体的地位与远程医疗利用率显著降低有关，这需要进一步调查少数群体公平使用远程医疗的问题。
证据水平
IV 级。
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