@文章{信息:doi/10.2196/34098，作者="马克思，格诺特和格雷纳，沃尔夫冈和尤赫拉，克里斯蒂安和埃尔肯坎普，斯韦尼亚和根索罗斯基，丹尼尔和莱曼，塞巴斯蒂安和英格布雷希特，扬和多曼，桑德拉和戈特沙尔克，安杰和哈弗坎普，米里亚姆和亨彭，安妮特和弗尔格尔-布莱恩海夫特，克里斯蒂安和贝斯，丹妮拉和舒尔茨-施泰宁，海娜和拉德马赫，苏珊娜和基斯特曼，詹妮弗和霍赫，斯特凡和贝克曼，汉斯-于尔根和兰科尔，克里斯蒂安和洛维奇，Volker和Peine, Arne和Juzek-Kuepper, Fabian和Benstoem, Carina和Sperling, Kathrin和Deisz, Robert”，标题=“一个创新的远程医疗网络改善危重患者和门诊患者的传染病管理(TELnet@NRW):阶梯形-楔形聚类随机控制试验”，期刊=“J医学互联网研究”，年=“2022”，月=“3”，日=“2”，卷=“24”，数=“3”，页数=“e34098”，关键词=“远程医疗;传染病医学;脓毒症;循证医学;背景:基于证据的传染病和重症监护管理比以往任何时候都更有意义。这两个学科的医学专业知识通常在地理上仅限于大学机构。此外，住院和门诊护理之间的互连往往不足(例如，没有共享电子健康记录，没有患者发现的数字传输)。目的:建立并评价基于专家远程会诊的远程住院门诊网络，以提高重症监护医学和传染病的治疗质量。方法:我们进行了一项多中心、阶梯式楔形聚类随机试验(2017年2月至2020年1月)，在德国北莱茵-威斯特法伦州的大学医院、医院和门诊医生之间建立远程医疗住院-门诊网络。 Patients aged ≥18 years in the intensive care unit or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand respectively once per week to enhance treatment quality. The primary outcome was adherence to the 10 Choosing Wisely recommendations for infectious disease management. Guideline adherence was analyzed using binary logistic regression models. Results: Overall, 159,424 patients (10,585 inpatients and 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (odds ratio [OR] 4.00, 95{\%} CI 1.83-9.20; P<.001) and in sepsis management in critically ill patients (OR 6.82, 95{\%} CI 1.27-56.61; P=.04). There was a statistically nonsignificant decrease in sepsis-related mortality from 29{\%} (19/66) in the control group to 23.8{\%} (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37, 95{\%} CI 1.52-111.47; P=.04). Patients treated by outpatient physicians, who were regularly participating in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34, 95{\%} CI 1.16-1.56; P<.001) and asymptomatic bacteriuria (OR 9.31, 95{\%} CI 3.79-25.94; P<.001). For the other recommendations, we found no significant effects, or we had too few observations to generate models. The key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects. Conclusions: Telemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management, creating added value for critically ill patients. Trial Registration: ClinicalTrials.gov NCT03137589; https://clinicaltrials.gov/ct2/show/NCT03137589 ", issn="1438-8871", doi="10.2196/34098", url="//www.mybigtv.com/2022/3/e34098", url="https://doi.org/10.2196/34098", url="http://www.ncbi.nlm.nih.gov/pubmed/35103604" }