TY - JOUR AU - Schweiberger, Kelsey AU - Hoberman, Alejandro AU - Iagnemma, Jennifer AU - Schoemer, Pamela AU - Squire, Joseph AU - Taormina, Jill AU - Wolfson, David AU - Ray, Kristin N PY - 2020 DA - 20/12/18 TI - COVID-19大流行期间儿科初级保健网络中远程医疗使用的实践水平变化:回顾性分析和调查研究JO - J医学互联网Res SP - e24345 VL - 22 IS - 12kw -远程医疗KW -远程医疗KW -门诊儿科KW -卫生服务研究KW -门诊KW -儿科KW -卫生服务KW - COVID-19 AB -背景:远程医疗，通过电信技术提供医疗保健，有潜力解决多个卫生系统问题。尽管有这种潜力，但截至2016年，只有15%的儿科初级保健临床医生报告使用远程医疗，大多数人认为这些服务的费用不足是采用远程医疗的最大障碍。2019冠状病毒病(COVID-19)大流行导致了围绕远程医疗的支付和法规的迅速变化，使其能够融入初级保健儿科。目的:由于在COVID-19大流行之前，远程医疗在儿科初级保健中的使用有限，因此对远程医疗在儿科初级保健中的作用知之甚少。为了解决这一知识差距，我们研究了大型儿科初级保健网络中实践水平的远程医疗使用与实践特征、远程医疗访问诊断、亲自访问量、儿童水平的远程医疗使用差异以及临床医生对远程医疗的态度之间的关系。方法:我们分析了45个初级保健实践的电子健康记录数据，并对实践临床医生进行了临床医生调查。实践根据两周期间(2020年4月19日至5月2日)每周每1000名患者的远程医疗使用率(低、中、高)进行分层。通过实践统计，我们比较了(1)实践特征，(2)远程医疗访问诊断，(3)亲自访问办公室、紧急护理和急诊科的比率，(4)儿童远程医疗使用水平的差异，以及(5)临床医生在这些实践中对远程医疗的态度。结果:在儿科初级保健实践中，远程医疗访问率为每周每1000名患者5至23次远程医疗访问。 Across all tertiles, the most frequent telemedicine visit diagnoses were mental health (28%-36% of visits) and dermatologic (15%-28%). Compared to low telemedicine use practices, high telemedicine use practices had fewer in-person office visits (10 vs 16 visits per 1000 patients per week, P=.005) but more total encounters overall (in-office and telemedicine: 28 vs 22 visits per 1000 patients per week, P=.006). Telemedicine use varied with child age, race and ethnicity, and recent preventive care; however, no significant interactions existed between these characteristics and practice-level telemedicine use. Finally, clinician attitudes regarding the usability and impact of telemedicine did not vary significantly across tertiles. Conclusions: Across a network of pediatric practices, we identified significant practice-level variation in telemedicine use, with increased use associated with more varied telemedicine diagnoses, fewer in-person office visits, and increased overall primary care encounter volume. Thus, in the context of the pandemic, when underutilization of primary care was prevalent, higher practice-level telemedicine use supported pediatric primary care encounter volume closer to usual rates. Child-level telemedicine use differed by child age, race and ethnicity, and recent preventive care, building upon prior concerns about differences in access to telemedicine. However, increased practice-level use of telemedicine services was not associated with reduced or increased differences in use, suggesting that further work is needed to promote equitable access to primary care telemedicine. SN - 1438-8871 UR - //www.mybigtv.com/2020/12/e24345/ UR - https://doi.org/10.2196/24345 UR - http://www.ncbi.nlm.nih.gov/pubmed/33290244 DO - 10.2196/24345 ID - info:doi/10.2196/24345 ER -