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使用远程评估工具替代常规门诊护理:范围综述

Use of Remote Assessment Tools to Substitute Routine Outpatient Care: Scoping Review.

作者信息

Barclay Jayne, Sullivan Clair, Beckmann Michael, Mattison Graeme, Runciman Rebecca, Martin Elizabeth

机构信息

School of Medicine, University of Queensland, Brisbane, Australia.

Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.

出版信息

J Med Internet Res. 2025 Mar 4;27:e65938. doi: 10.2196/65938.

Abstract

BACKGROUND

The increasing global demand for health care, driven by demographic shifts, the rise of personalized medicine, and technological innovations necessitate novel approaches to health care delivery. Digital remote assessment tools have emerged as a promising solution, enabling hybrid care models that combine traditional and remote patient management. These tools support the quadruple aim of health care by enhancing the monitoring and evaluation of patient-reported data, thereby improving patient care, boosting operational efficiency, reducing costs, and improving the experience of patients and clinicians. This review seeks to understand how remote assessment tools are used for routine consultation substitution in adult tertiary care centers.

OBJECTIVE

This scoping review aims to evaluate the implementation and health outcomes of digital remote assessment tools used for routine consultation substitutions in adult tertiary care centers. The objectives include assessing the extent of use, types, and effectiveness of these tools in substituting conventional outpatient care.

METHODS

A comprehensive scoping review was conducted, adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The review focused on studies that used internet-dependent remote assessment technologies for patient data transfer in tertiary care settings. A detailed search strategy was used across multiple databases, with studies selected based on predefined inclusion and exclusion criteria. Data extraction and analysis were performed by independent reviewers, with a focus on the functionalities of the tools and their alignment with the Quadruple Aim of Healthcare.

RESULTS

The review included 12 studies, highlighting a growing interest in remote assessment technologies across diverse clinical settings. The interventions varied in length, from 4 weeks to 12 months, and demonstrated a range of functionalities, including symptom monitoring and postsurgical follow-ups. The use of these tools was associated with improved clinical outcomes, such as timely intervention for clinical deterioration and enhanced clinical protocol adherence. Additionally, a small number of studies identified potential cost savings in terms of reduced unplanned health care contacts and optimized clinical resource use. Patient and clinician experiences were generally positive, with high adherence to remote assessments and an appreciation for the personalized and timely care facilitated by these technologies. Barriers included high initial setup costs for digital technologies, leading to an inflated cost per patient in small sample studies.

CONCLUSIONS

Digital remote assessment tools offer significant potential to enhance health care delivery by improving health outcomes, reducing costs, and enriching patient and clinician experiences. Their flexibility and adaptability make them suitable for various clinical contexts, supporting the personalization of care and operational efficiency. While digital remote assessment tools offer significant potential, careful consideration of implementation strategies, equity, cost, and clinician and patient experiences is crucial for successful clinical integration.

摘要

背景

人口结构变化、个性化医疗的兴起以及技术创新推动全球对医疗保健的需求不断增加,这就需要采用新颖的医疗保健提供方式。数字远程评估工具已成为一种有前景的解决方案,可实现结合传统和远程患者管理的混合护理模式。这些工具通过加强对患者报告数据的监测和评估来支持医疗保健的四重目标,从而改善患者护理、提高运营效率、降低成本并改善患者和临床医生的体验。本综述旨在了解远程评估工具如何在成人三级护理中心用于常规会诊替代。

目的

本范围综述旨在评估用于成人三级护理中心常规会诊替代的数字远程评估工具的实施情况和健康结果。目标包括评估这些工具在替代传统门诊护理方面的使用程度、类型和有效性。

方法

遵循PRISMA-ScR(系统评价和元分析扩展的范围综述的首选报告项目)清单进行了全面的范围综述。该综述重点关注在三级护理环境中使用依赖互联网的远程评估技术进行患者数据传输的研究。在多个数据库中使用了详细的搜索策略,根据预定义的纳入和排除标准选择研究。由独立评审员进行数据提取和分析,重点关注工具的功能及其与医疗保健四重目标的一致性。

结果

该综述纳入了12项研究,突出了不同临床环境中对远程评估技术的兴趣日益浓厚。干预措施的时长各不相同,从4周到12个月不等,并展示了一系列功能,包括症状监测和术后随访。使用这些工具与改善临床结果相关,例如对临床恶化的及时干预和增强的临床方案依从性。此外,少数研究确定在减少计划外医疗接触和优化临床资源使用方面可能节省成本。患者和临床医生的体验总体上是积极的,对远程评估的依从性很高,并赞赏这些技术所带来的个性化和及时的护理。障碍包括数字技术的高初始设置成本,导致小样本研究中每位患者的成本过高。

结论

数字远程评估工具通过改善健康结果、降低成本以及丰富患者和临床医生的体验,具有显著的潜力来提升医疗保健服务。它们的灵活性和适应性使其适用于各种临床环境,支持护理的个性化和运营效率。虽然数字远程评估工具具有巨大潜力,但仔细考虑实施策略、公平性、成本以及临床医生和患者的体验对于成功的临床整合至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fca/11920651/32c033284fc6/jmir_v27i1e65938_fig1.jpg

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