Department of Ophthalmology, University of California, San Francisco.
School of Medicine, University of California, San Francisco.
JAMA Ophthalmol. 2023 Jan 1;141(1):56-61. doi: 10.1001/jamaophthalmol.2022.4984.
Telehealth in ophthalmology has traditionally focused on preventive disease screening with limited use in outpatient evaluation. The unique conditions of the COVID-19 pandemic afforded the opportunity to evaluate different implementations of teleophthalmology at scale, providing insight into expanding teleophthalmology care.
To compare telehealth use in ophthalmology with other specialties and assess the feasibility of augmenting ophthalmic telehealth encounters with asynchronous testing during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study evaluated retrospective, longitudinal, observational data from the first 18 months of the COVID-19 pandemic (January 1, 2020, through July 31, 2021) for 881 080 patients receiving care from outpatient primary care, cardiology, neurology, gastroenterology, surgery, neurosurgery, urology, orthopedic surgery, otolaryngology, obstetrics/gynecology, and ophthalmology clinics of the University of California, San Francisco. Asynchronous testing was evaluated for teleophthalmology encounters.
A hybrid care model wherein ophthalmic testing data were acquired asynchronously and used to augment telehealth encounters.
Telehealth as a percentage of total volume of ambulatory care and use of asynchronous testing for ophthalmic conditions.
The volume of in-person outpatient visits dropped by 83.3% (39 488 of 47 390) across the evaluated specialties at the onset of shelter-in-place orders for the COVID-19 pandemic, and the initial use of telehealth increased for these specialties before stabilizing over the 18-month study period. In ophthalmology, telehealth use peaked at 488 of 1575 encounters (31.0%) early in the pandemic and returned to mostly in-person visits as COVID-19 restrictions lifted. Elective use of telehealth was highest in gastroenterology, urology, neurology, and neurosurgery and lowest in ophthalmology. Asynchronous testing was combined with 126 teleophthalmology encounters, resulting in change of clinical management for 32 patients (25.4%) and no change for 91 (72.2%).
Telehealth increased across various specialties during the COVID-19 pandemic. Combining teleophthalmic visits with asynchronous testing suggested that this approach is feasible for subspecialty-level evaluation. Additional study is needed to evaluate whether asynchronous testing outside the same institution could provide an effective and lasting approach for expanding the reach of ophthalmic telehealth.
眼科的远程医疗传统上侧重于预防性疾病筛查，在门诊评估中的应用有限。COVID-19 大流行的独特情况为大规模评估远程眼科学的不同实施提供了机会，为扩大远程眼科学护理提供了深入了解。
将眼科的远程医疗使用情况与其他专业进行比较，并评估在 COVID-19 大流行期间通过异步测试来增强眼科远程医疗就诊的可行性。
设计、地点和参与者：本质量改进研究评估了 2020 年 1 月 1 日至 2021 年 7 月 31 日 COVID-19 大流行的前 18 个月期间（881080 名）从加利福尼亚大学旧金山分校的门诊初级保健、心脏病学、神经病学、胃肠病学、外科、神经外科、泌尿科、骨科/整形外科、耳鼻喉科、妇产科和眼科诊所接受护理的患者的回顾性、纵向、观察性数据。对远程眼科就诊进行了异步测试评估。
混合护理模式，其中异步获取眼科测试数据并用于增强远程医疗就诊。
远程医疗占门诊量的百分比以及用于眼科疾病的异步测试的使用情况。
在 COVID-19 大流行期间下达就地避难令后，评估的专业中，门诊就诊量下降了 83.3%（39488 例中的 47390 例），这些专业最初增加了远程医疗的使用，然后在 18 个月的研究期间稳定下来。在眼科，远程医疗的使用在大流行早期达到 1575 次就诊中的 488 次（31.0%），随着 COVID-19 限制的放宽，又恢复为主要的门诊就诊。胃肠病学、泌尿科、神经病学和神经外科的远程医疗选择性使用最高，而眼科最低。将异步测试与 126 次远程眼科就诊相结合，导致 32 名患者（25.4%）的临床管理发生变化，91 名患者（72.2%）无变化。
在 COVID-19 大流行期间，各种专业的远程医疗都有所增加。将远程眼科就诊与异步测试相结合表明，这种方法对于专科评估是可行的。需要进一步研究评估同一机构以外的异步测试是否可以为扩大眼科远程医疗的覆盖面提供一种有效且持久的方法。
