Rini James Fraser, Tsoy Elena, Peet Bradley, Best John, Tanner Jeremy A, Asken Breton M, Sanchez Alejandra, Apple Alexandra C, VandeVrede Lawren, Stephens Melanie L, Erkkinen Michael, Kramer Joel H, Miller Bruce L
Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM).
Neurol Clin Pract. 2022 Dec;12(6):e199-e209. doi: 10.1212/CPJ.0000000000200099.
In response to the restrictions imposed by the COVID-19 pandemic, the University of California San Francisco Memory and Aging Center (UCSF MAC) has deployed a comprehensive telemedicine model for the diagnosis and management of Alzheimer disease and related dementias. This review summarizes a large academic behavioral neurology clinic's experience transitioning to telemedicine services, including the impact on clinic care indicators, access metrics, and provider's experience. We compared these outcomes from 3 years before COVID-19 to 12 months after the transition to video teleconferencing (VTC) encounters.
Patient demographics and appointment data (dates, visit types, and departments) were extracted from our institution's electronic health record database from January 1, 2017, to May 1, 2021. We present data as descriptive statistics and comparisons using Wilcoxon rank-sum tests and Fisher exact tests. The results of anonymous surveys conducted among the clinic's providers are reported as descriptive findings.
After the implementation of telemedicine services, the proportion of clinic encounters completed via VTC increased from 1.9% to 86.4%. There was a statistically significant decline in both the percentage of scheduled appointments that were canceled (32.9% vs 27.9%; < 0.01) and total cancelations per month (mean 240.3 vs 179.4/mo; < 0.01). There was an increase in the percentage of completed scheduled appointments (60.2% vs 64.8%; < 0.01) and an increase in the average estimated commuting distance patients would need to drive for follow-up appointments (mean 49.8 vs 54.7 miles; < 0.01). The transition to telemedicine services did not significantly affect the clinic's patient population as measured by age, gender, estimated income, area deprivation index, or self-reported racial/ethnic identity. The results of the provider survey revealed that physicians reported a more positive experience relative to neuropsychologists. Both types of providers reported telemedicine services as a reasonable equivalent and acceptable alternative to in-person evaluations with notable caveats.
UCSF MAC's comprehensive integration of telemedicine services maintained critical ambulatory care to patients living with dementia during the COVID-19 pandemic. The recognized benefits of our care model suggest dementia telemedicine may be used as a feasible and equivalent alternative to in-person ambulatory care in the after COVID-19 era.
为应对2019冠状病毒病疫情带来的限制，加利福尼亚大学旧金山分校记忆与衰老中心（UCSF MAC）已部署了一种全面的远程医疗模式，用于阿尔茨海默病及相关痴呆症的诊断和管理。本综述总结了一家大型学术行为神经病学诊所向远程医疗服务过渡的经验，包括对临床护理指标、就诊指标和提供者体验的影响。我们比较了2019冠状病毒病疫情前3年与过渡到视频电话会议（VTC）就诊后12个月的这些结果。
从我们机构的电子健康记录数据库中提取2017年1月1日至2021年5月1日的患者人口统计学和预约数据（日期、就诊类型和科室）。我们将数据以描述性统计数据呈现，并使用Wilcoxon秩和检验和Fisher精确检验进行比较。诊所提供者中进行的匿名调查结果以描述性发现报告。
实施远程医疗服务后，通过VTC完成的临床就诊比例从1.9%增至86.4%。取消的预约百分比（32.9%对27.9%；P<0.01）和每月取消总数（平均240.3次对179.4次/月；P<0.01）均有统计学显著下降。完成的预约百分比增加（60.2%对64.8%；P<0.01），患者随访预约预计需驾车行驶的平均距离增加（平均49.8英里对54.7英里；P<0.01）。以年龄、性别、估计收入、地区贫困指数或自我报告的种族/族裔身份衡量，向远程医疗服务的过渡并未显著影响诊所的患者群体。提供者调查结果显示，相对于神经心理学家，医生报告的体验更积极。两类提供者均报告远程医疗服务是面对面评估的合理等效且可接受的替代方式，但有明显的注意事项。
UCSF MAC对远程医疗服务的全面整合在2019冠状病毒病疫情期间为痴呆症患者维持了关键的门诊护理。我们护理模式的公认益处表明，痴呆症远程医疗在2019冠状病毒病疫情后时代可作为面对面门诊护理的可行等效替代方式。
