TY -非盟的马克思,Gernot AU -格林尼沃尔夫冈•AU - Juhra基督教非盟- Elkenkamp Svenja盟——Gensorowsky丹尼尔盟——Lemmen塞巴斯蒂安盟——Englbrecht Jan AU - Dohmen桑德拉AU - Gottschalk以及Antje盟——Haverkamp米利暗盟,大麻的安妮特盟——Flugel-Bleienheuft基督教非盟- Bause,丹妮拉盟——Schulze-Steinen,指甲花盟——随处Susanne AU - Kistermann,詹妮弗AU -霍克,Stefan AU -贝克曼,汉斯盟——Lanckohr基督教非盟- Lowitsch Volker盟——痛苦,Arne AU - Juzek-Kuepper,费边盟——Benstoem船底座非盟-斯珀林,凯瑟琳盟——Deisz罗伯特PY - 2022 DA - 2022/3/2 TI -一个创新Telemedical网络改善危重病人和门诊病人的传染病管理(TELnet@NRW): Stepped-Wedge集群随机对照试验乔- J地中海互联网Res SP - e34098六世- 24 - 3 KW -远程医疗KW -传染病医学KW -败血症KW -循证医学KW -电子健康AB -背景:以证据为基础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。在重症监护室或在门诊向医生咨询的年龄≥18岁的患者符合条件。我们通过高级培训课程和专家远程会诊提供重症专科医生和传染病专家的专业知识，每周一次，每周7天，每天24小时，每周365天，按需提供，以提高治疗质量。主要结果是遵守传染病管理的10项明智选择建议。 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 SN - 1438-8871 UR - //www.mybigtv.com/2022/3/e34098 UR - https://doi.org/10.2196/34098 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103604 DO - 10.2196/34098 ID - info:doi/10.2196/34098 ER -