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通过实施虚拟医院推进区域和远程医疗保健:快速综述

Advancing Regional and Remote Health Care With Virtual Hospital Implementation: Rapid Review.

作者信息

Kumari Artika Archana, Wani Tafheem Ahmad, Liem Michael, Boyd James, Khan Urooj Raza

机构信息

Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Australia.

出版信息

JMIR Hum Factors. 2025 Jun 3;12:e64582. doi: 10.2196/64582.

Abstract

BACKGROUND

Disparities in health equity between metropolitan and rural areas are a global concern, especially in vast countries such as Australia, Canada, and the United States. Virtual care models in health care settings are promising in reducing inequalities, with virtual hospitals (VHs) potentially bridging the gap for isolated or underserved regions. However, evidence-based strategies and the complexities of VH implementation necessitate further research.

OBJECTIVE

This rapid review aims to examine the role of VHs in enhancing regional and remote health care by focusing on accessibility, patient and health care provider experiences, and implementation barriers and facilitators. It provides tailored recommendations for large-scale implementation in communities with access issues, contributing to the discussion on equitable health care.

METHODS

A rapid review was conducted in accordance with the World Health Organization guidelines. A systematic search was performed across PubMed, MEDLINE, CINAHL, and the La Trobe University Library for peer-reviewed articles published between January 2015 and March 2023. Additional gray literature was identified through Google searches and snowballing from relevant web articles. Studies were included if they focused on regional or remote populations and addressed VHs or virtual care. Studies that solely discussed hybrid models of care were excluded. Data were systematically extracted using a customized Microsoft Excel template. A mixed methods thematic analysis was conducted to identify recurring themes, barriers, facilitators, and recommendations related to VH implementation as well as patterns in clinical outcomes and stakeholder perspectives.

RESULTS

A total of 35 articles were included in this review, comprising 23 (66%) peer-reviewed studies and 12 (34%) gray literature sources. Positive clinical outcomes were reported in 9 (26%) articles, highlighting outcomes such as reduced disease transmission, improved patient safety, fewer admissions and readmissions, lower mortality, shorter hospital stays, and better adherence to clinical best practices. Health system outcomes were identified in 15 (43%) articles, including reduced costs, enhanced patient experience and safety, improved care delivery and health care provider support, greater efficiency, broader geographic coverage, and better integration of services. Patient and health care provider perspectives were discussed in 12 (34%) articles, with positive views attributed to convenience, time and cost savings, and improved service quality. Barriers and facilitators were the most frequently discussed themes, appearing in 27 (77%) and 26 (74%) articles, respectively, with challenges and enablers commonly linked to people, processes, technology, and financial sustainability.

CONCLUSIONS

VHs have the potential to revolutionize regional and remote health care by overcoming barriers, using facilitators, and following recommended practices, leading to better clinical outcomes and increased satisfaction for patients and health care providers.

摘要

背景

大城市和农村地区在健康公平方面的差异是一个全球关注的问题,尤其是在澳大利亚、加拿大和美国等幅员辽阔的国家。医疗保健环境中的虚拟护理模式有望减少不平等现象,虚拟医院(VHs)有可能弥合偏远或服务不足地区的差距。然而,基于证据的策略以及虚拟医院实施的复杂性需要进一步研究。

目的

本快速综述旨在通过关注可及性、患者和医疗保健提供者的体验以及实施障碍和促进因素,探讨虚拟医院在加强区域和远程医疗保健方面的作用。它为存在就医问题的社区大规模实施提供了针对性建议,有助于关于公平医疗保健的讨论。

方法

根据世界卫生组织的指南进行了快速综述。在PubMed、MEDLINE、CINAHL和拉筹伯大学图书馆进行了系统检索,以查找2015年1月至2023年3月期间发表的同行评审文章。通过谷歌搜索和从相关网络文章中滚雪球的方式确定了其他灰色文献。如果研究关注区域或远程人群并涉及虚拟医院或虚拟护理,则纳入研究。仅讨论混合护理模式的研究被排除。使用定制的Microsoft Excel模板系统地提取数据。进行了混合方法主题分析,以确定与虚拟医院实施相关的反复出现的主题、障碍、促进因素和建议,以及临床结果和利益相关者观点的模式。

结果

本综述共纳入35篇文章,包括23篇(66%)同行评审研究和12篇(34%)灰色文献来源。9篇(26%)文章报告了积极的临床结果,突出了疾病传播减少、患者安全改善、入院和再入院次数减少、死亡率降低、住院时间缩短以及更好地遵循临床最佳实践等结果。15篇(43%)文章确定了卫生系统结果,包括成本降低、患者体验和安全增强、护理提供和医疗保健提供者支持改善、效率提高、地理覆盖范围扩大以及服务整合更好。12篇(34%)文章讨论了患者和医疗保健提供者的观点,积极的观点归因于便利性、节省时间和成本以及服务质量提高。障碍和促进因素是讨论最频繁的主题,分别出现在27篇(77%)和26篇(74%)文章中挑战和推动因素通常与人员、流程、技术和财务可持续性相关。

结论

虚拟医院有潜力通过克服障碍、利用促进因素并遵循推荐的做法来彻底改变区域和远程医疗保健,从而带来更好的临床结果,并提高患者和医疗保健提供者的满意度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1fa1/12174879/672e3cfba927/humanfactors_v12i1e64582_fig1.jpg

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