Texas Children's Hospital, Baylor College of Medicine (E.W., C.W., A.B., M.H., K.J.N., D.T.N.,J.C., J.A.J.), Houston, Texas, USA.
Texas Children's Hospital, Baylor College of Medicine (E.W., C.W., A.B., M.H., K.J.N., D.T.N.,J.C., J.A.J.), Houston, Texas, USA.
J Pain Symptom Manage. 2024 Jun;67(6):561-570.e1. doi: 10.1016/j.jpainsymman.2024.03.014. Epub 2024 Mar 19.
Studies suggest the feasibility and acceptability of telehealth in outpatient pediatric palliative care. However, there is a need for data that describes the implementation and quality of telehealth, relying on objective and validated measures.
We sought to compare the provision of pediatric palliative care by delivery method.
We conducted a retrospective electronic health record review of patients seen by our outpatient palliative care team over a two-year period. Demographic, diagnostic, and health utilization data as well as encounter characteristics were compared between patients seen in person (IP), through telehealth (TH), and both (IP/TH).
Three hundred ninety-four patients were evaluated with 889 outpatient pediatric palliative care encounters. Non-English speaking patients were less likely to receive palliative care through TH, as were patients without active patient portals. Median follow-up time was longer for patients seen through TH or IP/TH. Patients with malignancies were seen more frequently IP while children with neurologic diagnoses, technology dependence, and a higher number of complex chronic conditions were seen more frequently via TH. Health outcomes, end of life quality metrics, and encounter-level quality indicators were similar across care delivery methods. Review of systems, pain, and mood management, and advance care planning happened more frequently IP while goals of care discussions and medical decision-making happened more through TH.
Despite differences in patients seen and palliative interventions provided in person compared to telehealth, health outcomes, and quality indicators were similar across care delivery methods. These data support the continued practice of telehealth in palliative care and highlight the need for equity in its evolution.
研究表明远程医疗在儿科姑息治疗门诊中具有可行性和可接受性。然而，需要有数据来描述远程医疗的实施和质量，这些数据依赖于客观和经过验证的措施。
我们旨在比较通过不同方式提供儿科姑息治疗的情况。
我们对我们的门诊姑息治疗团队在两年期间诊治的患者进行了回顾性电子病历审查。比较了通过亲自就诊（IP）、远程医疗（TH）和两者兼有（IP/TH）方式就诊的患者的人口统计学、诊断和健康利用数据以及就诊特征。
共评估了 394 名患者，有 889 次门诊儿科姑息治疗就诊。非英语患者通过 TH 接受姑息治疗的可能性较小，而没有活动患者门户的患者也是如此。通过 TH 或 IP/TH 就诊的患者中位随访时间更长。恶性肿瘤患者更常通过 IP 就诊，而患有神经疾病、技术依赖和更多复杂慢性病的儿童更常通过 TH 就诊。不同治疗方式的健康结果、生命终末期质量指标和就诊级别质量指标相似。系统回顾、疼痛和情绪管理以及预先护理计划在 IP 就诊时更常见，而目标治疗讨论和医疗决策则更常通过 TH 进行。
尽管亲自就诊和远程医疗就诊的患者存在差异，以及提供的姑息治疗干预措施不同，但不同治疗方式的健康结果和质量指标相似。这些数据支持在姑息治疗中继续实践远程医疗，并强调需要在其发展过程中实现公平。
