Pfarr Marie A, Odum James D, Thomson Joanna, Callahan Scott, Tegtmeyer Ken, Pulda Kathleen, Rummel Michelle, Ruschman Jennifer, Herrmann Lisa E
Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Alabama, Birmingham, Alabama, USA.
Division of Pediatric Critical Care, Department of Pediatrics, University of Alabama, Birmingham, Alabama, USA.
Telemed J E Health. 2024 Dec;30(12):2870-2875. doi: 10.1089/tmj.2024.0058. Epub 2024 Aug 20.
Children with medical complexity (CMC) account for high health care utilization. Telemedicine holds significant potential in CMC, as it allows a provider to engage with CMC in their home environment and can alleviate both financial and transportation burdens. Remote exam devices that enable the performance of a physical exam could expand the ability of providers to clinically assess CMC during a telemedicine visit. In this pilot study, our goal was to develop a process for integrating an in-home remote exam device into a complex care clinic during the COVID-19 pandemic and evaluate the usability and feasibility of this device. The remote exam device was distributed to caregivers of CMC cared for at a complex care outpatient center. Using deliberate practice framework, our onboarding process provided opportunities for caregivers and providers to learn how to utilize the device. Surveys examining usability and feasibility were administered to both caregivers and providers after each telemedicine encounter. A total of 43 caregivers participated in the onboarding process, which included a total of 83 practice visits. The remote exam device was rated as having excellent usability by caregivers; however, providers rated the device as having lower usability. Feasibility was notable for technology issues contributing to 15% of encounters being cancelled or ending early. The remote exam device was successfully integrated into a complex care clinic. Data from this pilot study supports the usability and feasibility of deploying a remote exam device across a telemedicine platform in a busy and complex outpatient academic practice.
患有复杂病症（CMC）的儿童医疗保健利用率很高。远程医疗在CMC方面具有巨大潜力，因为它使医疗服务提供者能够在患儿家中与他们接触，并可减轻经济和交通负担。能够进行体格检查的远程检查设备可以扩大医疗服务提供者在远程医疗就诊期间对CMC进行临床评估的能力。在这项试点研究中，我们的目标是开发一种在新冠疫情期间将家用远程检查设备整合到复杂病症护理诊所的流程，并评估该设备的可用性和可行性。远程检查设备分发给了在复杂病症护理门诊中心接受治疗的CMC的护理人员。利用刻意练习框架，我们的入职培训流程为护理人员和医疗服务提供者提供了学习如何使用该设备的机会。在每次远程医疗会诊后，对护理人员和医疗服务提供者进行了关于可用性和可行性的调查。共有43名护理人员参与了入职培训流程，其中包括总共83次练习就诊。护理人员对远程检查设备的可用性评价很高；然而，医疗服务提供者对该设备的可用性评价较低。由于技术问题，15%的会诊被取消或提前结束，可行性方面存在显著问题。远程检查设备已成功整合到复杂病症护理诊所。这项试点研究的数据支持了在繁忙且复杂的门诊学术实践中，通过远程医疗平台部署远程检查设备的可用性和可行性。
