Feng Xiaodong, Zhang Guiliang, Zhang Shiyang, Chen Dihong, Zhou Mengxue, Zeng Lihua, Yang Tianmin
Department of Critical Care Medicine, Mianzhu People's Hospital, Mianzhu, 618200, People's Republic of China.
Department of Gastroenterology, Mianzhu People's Hospital, Mianzhu, 618200, People's Republic of China.
J Multidiscip Healthc. 2022 Dec 9;15:2809-2815. doi: 10.2147/JMDH.S390711. eCollection 2022.
To explore an effective model to promote the homogeneous development of intensive care units (ICUs) in grassroot, impoverished and remote areas.
A three-level remote alliance model (in-place and online assistance) was adopted to guide the cross-talk of ICUs between counties and cities. The observed indicators included the mortality of ICU patients and those with APACHE II scores ≥15 points, deep vein thrombosis, ventilator-associated pneumonia, the completion rate of septic shock goals in 3-hour and 6-hour bundles, and the rates of patient transfers.
After the implementation of the remote alliance, there was significant reduction in the mortality of ICU patients in the county and city-level tertiary hospitals (7.6% vs 4.5%, = 0.004; OR = 1.734, 95% CI 1.189-2.532) and the mortality rates of patients with APACHE II scores ≥15 points (11.9% vs 7.1%, = 0.004; OR = 1.763, 95% CI 1.189-2.614). There was a significant reduction in the incidence of ventilator-associated pneumonia (0.9% vs 5.0%, < 0.001) and deep vein thrombosis (52.4% vs 13.6%, < 0.001). The completion rate of 3-hour bundle therapies for septic shock was significantly improved (95.7% vs 68.4%, < 0.001), as well as 6-hour bundle therapies for septic shock (97.9% vs 81.6%, < 0.001). The hospital transfer rate decreased significantly in the grassroots and impoverished areas (2.6% vs 4.7%, < 0.001).
A three-level remote alliance might be helpful in improving the quality of critical care in remote areas and promoting the homogeneous development of disciplines.
探索一种促进基层、贫困及偏远地区重症监护病房（ICU）同质化发展的有效模式。
采用三级远程联盟模式（现场与在线协助）指导市县两级ICU之间的交流。观察指标包括ICU患者及急性生理学与慢性健康状况评分系统（APACHE II）≥15分患者的死亡率、深静脉血栓形成、呼吸机相关性肺炎、感染性休克3小时和6小时集束治疗目标完成率以及患者转院率。
远程联盟实施后，市县两级三级医院ICU患者死亡率显著降低（7.6%对4.5%，P = 0.004；比值比[OR]=1.734，95%可信区间[CI] 1.189 - 2.532），APACHE II评分≥15分患者的死亡率也显著降低（11.9%对7.1%，P = 0.004；OR = 1.763，95% CI 1.189 - 2.614）。呼吸机相关性肺炎发病率显著降低（0.9%对5.0%，P < 0.001），深静脉血栓形成发生率也显著降低（52.4%对13.6%，P < 0.001）。感染性休克3小时集束治疗的完成率显著提高（95.7%对68.4%，P < 0.001），感染性休克6小时集束治疗的完成率也显著提高（97.9%对81.6%，P < 0.001）。基层和贫困地区的医院转院率显著下降（2.6%对4.7%，P < 0.001）。
三级远程联盟可能有助于提高偏远地区的重症监护质量并促进学科的同质化发展。
