Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States.
Department of Research and Education Services, Medical University of South Carolina, Charleston, SC, United States.
J Pediatr Surg. 2023 Aug;58(8):1527-1533. doi: 10.1016/j.jpedsurg.2022.10.008. Epub 2022 Oct 22.
Telehealth is a rapidly expanding care modality in the United States. Pediatric surgical patients often require complex care which can incur significant expenses, some of which may be alleviated by telehealth. We performed a systematic review comparing telehealth and in-person visits, and telehealth's impacts on the cost of healthcare across pediatric surgical specialties.
A systematic review was performed using the following databases: PubMed (MEDLINE), Scopus (Elsevier), and CINAHL (EBSCOHost), searched from inception to July 10th, 2022. Studies were included per the following criteria: (1) investigated a telehealth intervention for pediatric surgical care and (2) provided some metric of telehealth cost compared to an in-person visit. Non-English or studies conducted outside of the U.S. were excluded.
Fourteen manuscripts met inclusion criteria and presented data on 7992 visits, including patients with a weighted average age of 7.5 ± 3.5 years. Most (11/14) studies used telehealth in a synchronous, or "real-time" context. Of the studies which calculated dollar cost savings for telehealth visits compared to in-person appointments we found a substantial range of savings per visit, from $48.50 to $344.64. Cost savings were frequently realized in terms of reduced travel expenditures, lower opportunity costs (e.g. lost wages), and decreased hospital labor requirements.
This review suggests that telehealth provides cost incentives to pediatric surgical care in many scenarios, including post-operative visits and some routine clinic visits. Future work should focus on standardizing the metrics by which cost impacts are analyzed and detailing which visits are most appropriately facilitated by telehealth.
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远程医疗是美国迅速发展的医疗模式。儿科手术患者通常需要复杂的护理，这可能会产生巨大的费用，其中一些费用可以通过远程医疗来减轻。我们进行了一项系统评价，比较了远程医疗和面对面就诊，以及远程医疗对儿科外科各专业医疗保健成本的影响。
使用以下数据库进行了系统评价：PubMed（MEDLINE）、Scopus（Elsevier）和 CINAHL（EBSCOHost），检索时间从建库到 2022 年 7 月 10 日。符合以下标准的研究被纳入：（1）调查了远程医疗干预儿科手术护理，（2）提供了与面对面就诊相比的远程医疗成本的一些指标。不包括非英语或在美国境外进行的研究。
14 篇手稿符合纳入标准，共提供了 7992 次就诊的数据，包括患者的加权平均年龄为 7.5±3.5 岁。大多数（11/14）研究在同步或“实时”环境中使用远程医疗。在计算远程医疗就诊相对于面对面预约的节省成本的研究中，我们发现每次就诊的节省幅度从 48.50 美元到 344.64 美元不等。节省成本通常体现在减少旅行支出、降低机会成本（如工资损失）和减少医院劳动力需求方面。
本综述表明，在许多情况下，远程医疗为儿科手术护理提供了成本激励，包括术后就诊和一些常规诊所就诊。未来的工作应侧重于标准化分析成本影响的指标，并详细说明哪些就诊最适合通过远程医疗进行。
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