Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Hosp Pract (1995). 2022 Dec;50(5):379-386. doi: 10.1080/21548331.2022.2125726. Epub 2022 Sep 23.
The COVID-19 pandemic impacted the availability and accessibility of outpatient care following hospital discharge. Hospitalists (physicians) and hospital medicine advanced practice providers (HM-APPs) coordinate discharge care of hospitalized patients; however, it is unknown if they can deliver post-discharge virtual care and overcome barriers to outpatient care. The objective was to develop and provide post-discharge virtual care for patients discharged from hospital medicine services.
We developed the Post-discharge Early Assessment with Remote video Link (PEARL) initiative for HM-APPs to conduct a post-discharge video visit (to review recommendations) and telephone follow-up (to evaluate adherence) with patients 2-6 days following hospital discharge. Participants included patients discharged from hospital medicine services at an institution's hospitals in Rochester (May 2020-August 2020) and Austin (November 2020-February 2021) in Minnesota, US. HM-APPs also interviewed patients about their experience with the video visit and completed a survey on their experience with PEARL.
Of 386 eligible patients, 61.4% were enrolled (n = 237/386) including 48.1% women (n = 114/237). In patients with complete video visit and telephone follow-up (n = 141/237), most were prescribed new medications (83.7%) and took them as prescribed (93.2%). Among five classes of chronic medications, patient-reported adherence ranged from 59.2% (narcotics) to 91.5% (anti-hypertensives). Patient-reported self-management of 12 discharge recommendations ranged from 40% (smoking cessation) to 100% (checking rashes). Patients reported benefit from the video visit (agree: 77.3%) with an equivocal preference for video visits over clinic visits. Among HM-APPs who responded to the survey (88.2%; n = 15/17), 73.3% reported benefit from visual contact with patients but were uncertain if video visits would reduce emergency department visits.
In this novel initiative, HM-APPs used video visits to provide care beyond their hospital role, reinforce discharge recommendations for patients, and reduce barriers to outpatient care. The effect of this initiative is under evaluation in a randomized controlled trial.
新冠疫情大流行影响了出院后的门诊医疗服务的可及性。医院医师（医生）和医院医学高级执业医师（HM-APP）负责协调住院患者的出院护理；然而，他们是否能够提供出院后的虚拟护理并克服门诊护理的障碍尚不清楚。目的是为从医院医学服务出院的患者提供出院后的虚拟护理。
我们为 HM-APP 开发了名为 Post-discharge Early Assessment with Remote video Link (PEARL) 的计划，以便在患者出院后 2-6 天进行视频访问（回顾建议）和电话随访（评估遵医嘱情况）。参与者包括在美国明尼苏达州罗彻斯特（2020 年 5 月至 2020 年 8 月）和奥斯汀（2020 年 11 月至 2021 年 2 月）医院的医院医学服务出院的患者。HM-APP 还询问了患者对视频访问的体验，并对他们使用 PEARL 的体验进行了调查。
在 386 名符合条件的患者中，有 61.4%（n=237/386）入组，其中 48.1%（n=114/237）为女性。在完成视频访问和电话随访的患者中（n=141/237），大多数患者服用了新的药物（83.7%），并按医嘱服用（93.2%）。在五类慢性药物中，患者报告的遵医嘱程度从 59.2%（麻醉药）到 91.5%（抗高血压药）不等。患者报告出院建议的 12 项自我管理措施的遵医嘱程度从 40%（戒烟）到 100%（检查皮疹）不等。患者报告从视频访问中受益（同意：77.3%），对视频访问和门诊就诊的偏好存在分歧。在对调查做出回应的 HM-APP 中（88.2%；n=15/17），73.3% 报告称与患者进行视觉接触有益，但不确定视频访问是否会减少急诊科就诊次数。
在这项新计划中，HM-APP 使用视频访问提供超出其医院角色的护理，强化患者的出院建议，并减少门诊护理的障碍。该计划的效果正在一项随机对照试验中进行评估。
