COVID-19 大流行期间养老院中远程医疗工作流程的特点。
Characteristics of telemedicine workflows in nursing homes during the COVID-19 pandemic.
机构信息
Social & Administrative Sciences Division, University of Wisconsin School of Pharmacy, 777 Highland Ave., Madison, WI, 53705, USA.
University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
出版信息
BMC Health Serv Res. 2023 Mar 29;23(1):301. doi: 10.1186/s12913-023-09249-2.
BACKGROUND
The use of telemedicine increased dramatically in nursing homes (NHs) during the COVID-19 pandemic. However, little is known about the actual process of conducting a telemedicine encounter in NHs. The objective of this study was to identify and document the work processes associated with different types of telemedicine encounters conducted in NHs during the COVID-19 pandemic.
METHODS
A mixed methods convergent study was utilized. The study was conducted in a convenience sample of two NHs that had newly adopted telemedicine during the COVID-19 pandemic. Participants included NH staff and providers involved in telemedicine encounters conducted in the study NHs. The study involved semi-structured interviews and direct observation of telemedicine encounters and post-encounter interviews with staff and providers involved in telemedicine encounters observed by research staff. The semi-structured interviews were structured using the Systems Engineering Initiative for Patient Safety (SEIPS) model to collect information about telemedicine workflows. A structured checklist was utilized to document steps performed during direct observations of telemedicine encounters. Information from interviews and observations informed the creation of a process map of the NH telemedicine encounter.
RESULTS
A total of 17 individuals participated in semi-structured interviews. Fifteen unique telemedicine encounters were observed. A total of 18 post-encounter interviews with 7 unique providers (15 interviews in total) and three NH staff were performed. A 9-step process map of the telemedicine encounter, along with two microprocess maps related to encounter preparation and activities within the telemedicine encounter, were created. Six main processes were identified: encounter planning, family or healthcare authority notification, pre-encounter preparation, pre-encounter huddle, conducting the encounter, and post-encounter follow-up.
CONCLUSION
The COVID-19 pandemic changed the delivery of care in NHs and increased reliance on telemedicine services in these facilities. Workflow mapping using the SEIPS model revealed that the NH telemedicine encounter is a complex multi-step process and identified weaknesses related to scheduling, electronic health record interoperability, pre-encounter planning, and post-encounter information exchange, which represent opportunities to improve and enhance the telemedicine encounter process in NHs. Given public acceptance of telemedicine as a care delivery model, expanding the use of telemedicine beyond the COVID-19 pandemic, especially for certain NH telemedicine encounters, could improve quality of care.
背景
在 COVID-19 大流行期间，养老院（NHs）中远程医疗的使用急剧增加。然而，对于 NHs 中进行远程医疗的实际过程知之甚少。本研究的目的是确定并记录与 COVID-19 大流行期间 NHs 中进行的不同类型的远程医疗相遇相关的工作流程。
方法
采用混合方法收敛研究。该研究在两个在 COVID-19 大流行期间新采用远程医疗的 NH 的便利样本中进行。参与者包括参与研究 NH 中进行的远程医疗的 NH 工作人员和提供者。该研究涉及对研究人员观察到的远程医疗参与进行半结构化访谈和直接观察以及与参与远程医疗的工作人员和提供者进行的事后访谈。半结构化访谈使用系统工程患者安全倡议（SEIPS）模型进行结构设计，以收集有关远程医疗工作流程的信息。使用结构化清单记录直接观察远程医疗过程中执行的步骤。访谈和观察的信息为 NH 远程医疗过程图的创建提供了信息。
结果
共有 17 人参加了半结构化访谈。观察到 15 次独特的远程医疗相遇。对 7 位独特的提供者（总共 15 次访谈）和 3 位 NH 工作人员进行了 18 次事后访谈。创建了远程医疗的 9 步流程图，以及与遇到准备和远程医疗中的活动相关的两个微流程图。确定了六个主要流程：遇到计划、家庭或医疗保健机构通知、预先准备、会前会议、进行会议以及会议后跟进。
结论
COVID-19 大流行改变了 NH 的护理提供方式，并增加了这些设施对远程医疗服务的依赖。使用 SEIPS 模型进行的工作流程映射表明，NH 远程医疗的相遇是一个复杂的多步骤过程，并确定了与调度、电子健康记录互操作性、预遇到计划和会议后信息交流相关的弱点，这代表了改进和加强 NH 远程医疗过程的机会。鉴于公众对远程医疗作为一种护理提供模式的接受程度，尤其是在某些 NH 远程医疗的相遇中，将远程医疗的使用范围扩大到 COVID-19 大流行之外，可以提高护理质量。
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