基于影像学技术的远程医疗系统对农村神经急症患者护理的健康经济影响。
The health economic effects of an imaging technology-based telemedicine system for rural neuro-emergency patient care.
机构信息
1Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan.
2Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Japan.
出版信息
Neurosurg Focus. 2022 Jun;52(6):E2. doi: 10.3171/2022.3.FOCUS228.
OBJECTIVE
"Join," an imaging technology-based telemedicine system, allows simultaneous radiological information sharing between physically remote institutions, virtually connecting advanced medical institutions and rural hospitals. This study aimed to elucidate the health economics effect of Join for neurological telemedicine in rural areas in Hokkaido, Japan.
METHODS
Information concerning 189 requests for patient transfer from Furano Kyokai Hospital, a regional rural hospital, to Asahikawa Medical University Hospital (AMUH), an advanced academic medical institution, was retrospectively collected. The Join system was established between Furano Kyokai Hospital and AMUH in February 2019. Data collected from patients between April 2017 and December 2018 were included in the non-Join group, and those collected between February 2019 and October 2020 were included in the Join group. Clinical variables, reasons for patient transfer requests, duration of hospital stay, and medical costs per patient were analyzed between these two groups. Furthermore, clinical characteristics were compared between patients who were transferred and not transferred based on Join.
RESULTS
More patients were discharged < 7 days after transfer to AMUH in the non-Join group compared with the Join group (p = 0.02). When focusing on the Join group, more patients who were not transferred were discharged < 1 week (p < 0.01). On the other hand, more patients required surgery (p = 0.01) when transferred. The ratio of patients whose medical cost was < USD5000 substantially decreased, from 33% for the non-Join group to 13% for the Join group.
CONCLUSIONS
An imaging technology-based telemedicine system, Join, contributed to reducing unnecessary neuro-emergency patient transfer in a remote rural area, and telemedicine with an integrated smartphone system allowed medical personnel to effectively triage at a distance neuro-emergency patients requiring advanced tertiary care.
目的
“Join”是一种基于成像技术的远程医疗系统，允许物理上远程的机构之间同时共享放射学信息，将先进的医疗机构与农村医院虚拟连接起来。本研究旨在阐明 Join 在日本北海道农村地区神经远程医疗的健康经济学效果。
方法
回顾性收集了来自地区农村医院富良野偕行会医院向先进学术医疗机构旭川医科大学医院（AMUH）转诊的 189 例患者的信息。2019 年 2 月，在富良野偕行会医院和 AMUH 之间建立了 Join 系统。将 2017 年 4 月至 2018 年 12 月期间收集的数据纳入非 Join 组，将 2019 年 2 月至 2020 年 10 月期间收集的数据纳入 Join 组。对两组患者的临床变量、转诊请求原因、住院时间和每位患者的医疗费用进行分析。此外，根据 Join 比较了转诊和未转诊患者的临床特征。
结果
非 Join 组中转到 AMUH 的患者中，有更多的患者在转移后 7 天内出院（p = 0.02）。在 Join 组中，更多未转院的患者在 1 周内出院（p < 0.01）。另一方面，更多需要手术的患者接受了转诊（p = 0.01）。非 Join 组中医疗费用<5000 美元的患者比例从 33%下降到 Join 组的 13%。
结论
基于成像技术的远程医疗系统 Join 有助于减少偏远农村地区不必要的神经急症患者转诊，而集成智能手机系统的远程医疗使医务人员能够有效地对需要高级三级护理的神经急症患者进行远程分诊。
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