Telemedicine and e-Health最新文献

Purposes: This study aims to use bibliometric analysis to explore the development, research hotspots, and trends in the field of telemedicine for surgical practices (TSPs). Methods: A bibliometric analysis of 3,235 documents from the Web of Science Core Collection was conducted, spanning from 2004 to 2022. Citespace (6.2.R5) was used to perform a bibliometric analysis. Results: The findings highlight a marked escalation in researches of TSPs, particularly between 2019 and 2022, aligning with the COVID-19 pandemic. The Telemedicine and e-Health Journal was the most productive journal with 118 publications, and Journal of Telemedicine and Telecare had the most citations (n = 700). Howard S. An and Mohammad El-sharkawi had the most papers (n = 8). Harvard University was the most prolific institution (n = 103). The United States, England, and Canada were identified as the predominant contributing countries with a total of 1,521 publications. There was a notable shift in research focus areas over time, with recent emphasis being placed on pediatric surgery, COVID-19-related studies, and orthopedics. Future trends may involve teleconsulting, ameliorating the quality and safety of telemedicine, and improving satisfaction levels of patients and caregivers when they are using telemedicine. Conclusions: The study reveals that the rapid and sustained advancement in TSPs, significantly driven by the COVID-19 pandemic, and huge gaps between developed countries and developing countries. This study also reflects the current hotspots and future directions for TSPs.

Introduction: Studies have shown that tele-critical care (TCC) improves outcomes in intensive care unit (ICU) settings with low baseline performance. Evidence also suggests that TCC outcomes may be modified by heterogenous baseline severity of illness. We examined the association of admission Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score quartiles (APQ1-APQ4) and TCC exposure with 30-day mortality. Methods: Retrospective, cohort study of 151,780 consecutive ICU patients admitted to nine hospitals within Cleveland Clinic Health System from 2010 to 2019. Data were abstracted from an institutional ICU Datamart and APACHE IV registry. Analyses included summary statistics for demographics, unadjusted survival functions, and incidence rates across ascending APACHE quartiles (APQ1-APQ4). Multivariate Poisson regression modeled covariates associated with incidence rate ratio (IRR) for mortality, across quartiles including statistical interaction between TCC exposure and APACHE quartiles. Results: Unadjusted mortality risk ratios of TCC/no TCC were statistically different across APQ1 (0.83; 95% confidence interval [CI] 0.71-0.97), APQ3 (0.63; 95% CI 0.57-0.69), and APQ4 (0.77; 95% CI 0.74-0.82) (all p < 0.05) but not in APQ2 (0.98; 95% CI 0.88-1.10; p = 0.77). Multivariate Poisson modeling found reduced IRR with TCC (IRR 0.82; 95% CI 0.70-0.97). Relative to APQ1, risk was increased across quartiles, APQ2 (IRR 2.15; 95% CI 1.83-2.52), APQ3 (IRR 3.93; 95% CI 3.39-4.56), and APQ4 (IRR 9.30; 95% CI 8.10-10.67). Interaction with TCC significantly reduced risk in APQ3 (IRR 0.80; 95% CI 0.67-0.96). Conclusion: TCC exposure is associated with reduced 30-day mortality, affected by various clinical factors, to provide heterogenous impact. Mortality benefit appears to particularly accrue among patients with higher, but not the highest quartile for severity of illness, based on their APACHE IV scores.

Background: The COVID-19 pandemic brought about a drastic increase in the utilization of telehealth services in place of or as a complement to in-person health services. Telehealth is a tool to help reduce disparities in the receipt of maternal health care. However, a stable internet connection is required for patients to connect to providers via telehealth; lack of internet connectivity is a barrier to maternal telehealth access. Methods: The objectives of this research were to determine whether community-level internet penetration is associated with community-level utilization of maternal telehealth services and assess the heterogeneity of this association across the maternal telehealth utilization spectrum. A cross-sectional study of community-level maternal telehealth is utilized in the United States in 2019. The underlying population is comprised of commercially insured maternal health patients receiving any antenatal, delivery-related, or postpartum care in the United States. The individual-level utilization data are aggregated to the geo-zip level (n = 404), which is a regional subdivision comprised of all zip codes that share the first three digits. Results: Findings show that the estimated relationship between the proportion of households with home-based internet connectivity was statistically significant at the 10th and 25th quantiles of maternal telehealth utilization. For these quantiles, an increase in community-level internet connectivity was associated with an increase in the utilization of maternal telehealth services. Conclusion: There is a positive association between community-level internet connectivity and maternal telehealth utilization, and the association varies in magnitude across the maternal telehealth utilization distribution. Policymakers should consider digital access when addressing telehealth policy for maternal care services.

Introduction: Telehealth shows promise in increasing access to specialty care for individuals who experience sexual assault. Methods: This study analyzed 466 cases from rural and urban hospitals between September 2018 and March 2024, examining telehealth acceptability rates and reasons for declination. Of 362 eligible cases, 89.5% accepted telehealth consultation. Among those who declined, 65.8% were not given the opportunity to interact with a telehealth sexual assault nurse examiner (teleSANE) during decision-making. Results: These findings indicate high acceptability of forensic sexual assault telehealth and suggest that providing patients the opportunity to interact with teleSANEs before deciding may further increase acceptance. Conclusion: The study contributes to understanding telehealth's viability for sexual assault care across diverse settings and demographics, supporting the potential of teleSANE programs to enhance equitable access to specialty care, particularly in underserved areas. This research addresses gaps in existing literature by exploring acceptability in a wide range of settings, demographics, and circumstances.

Objective: To explore the potential of gatekeeping for specialized consultations and patient care via remote interactions with family physicians. Methods: This cross-sectional study was conducted at a tertiary hospital between November 2020 and December 2021, when specialized consultations were canceled due to the COVID-19 pandemic. Patients who were evaluated for remote consultation with family physicians were included. Remote consultations were done by a family physician team facilitated through the TelessaúdeRS-UFRGS service. The primary outcome was potential patients eligible for discharge from specialty ambulatory to primary care. Data Sources and Analytic Sample: Data were collected from hospital records. Candidates for remote consult included stable health conditions, indicating the absence of acute or decompensated symptoms as reported in the consult request via the online platform, absence of necessity for any medical procedures or scheduled surgeries, and absence of time-sensitive situations. The prevalence of the outcome was estimated at a corresponding 95% confidence interval. The chi-square test compared the outcome according to COVID-19 mortality waves and specialty groups. Results: At the outset, 2,429 consultations were assessed against the study's eligibility criteria. Among these, 2,160 consultations were included, of whom 776 were candidates for family physician team consultation. Subsequently, the remote family physicians team conducted 557 (23% of the original sample) consultations. Overall, 10% (95% CI: 9-11) had the potential to be discharged from specialty care. Patients' age was linked to discharged likelihood. Prevalence rates varied across specialty groups (highest in surgical patients) and COVID-19 waves (highest in the second wave). Conclusions: This study, conducted within a tertiary hospital's specialty outpatient clinic, highlights the potential of remote consultations with a family physician team in identifying cases suitable for management in primary care settings. Our findings demonstrate that 10% of cases assessed through remote consultations exhibited potential for primary care management.

Background: Many neonatal intensive care units (NICUs) lack access to subspecialist consultants and may transfer patients requiring subspecialty care to referral facilities or seek informal consultation. The objective of this work was to evaluate the feasibility, acceptability, and impact of extending pediatric subspecialty services from a children's hospital to a level III NICU via teleconsultation and describe processes, facilitators, and challenges. Methods: Monitored consultations for 1 year and surveyed clinicians regarding feasibility, perceived benefits, and challenges. Results: Fifty-nine teleconsultations were conducted. NICU providers indicated improved care quality with subspecialty input. Subspecialists reported advantages of documenting, billing, and providing more complete care, but noted logistical strains. Both parties perceived better interdisciplinary communication. Conclusions: This teleconsultation service was feasible, generally acceptable, improved access to subspecialty services, and improved NICU clinicians' perceived care quality. Challenges included infrastructure development costs, workflow training time, logistics, and subspecialist patient volumes. This is among the first descriptions of a pediatric subspecialty teleconsultation service supporting a NICU.

Introduction: Few studies have explored patient choice of visit modality between in-person, video, and telephone for prenatal care where exams are viewed as core to care and how this choice impacts no-show rate. This study evaluated the association between choice of visit modality and prenatal care visit attendance. Methods: In this observational (July 2020-June 2022) mixed methods study of an urban safety-net obstetrics clinic, we collected sociodemographic traits, telemedicine eligibility (as determined by a clinician), choice of visit modality (in-person, telephone, and video), and visit completion status. Using logistic regression analysis, we evaluated associations between sociodemographic traits, telemedicine eligibility, and visit modality with visit completion among all visits and only telemedicine-eligible visits. We interviewed patients and used thematic analysis to explore reasons for choosing a telemedicine visit and their visit experience. Results: Of 504 participants, there were 1,311 visits and 554 telemedicine-eligible visits. The no-show rate was 11.3% (148/1,311) among all visits and 14.1% (78/554) in telemedicine-eligible visits. Only phone visits were associated with higher odds of no-shows (vs. in-person visits) (adjusted odds ratio [aOR] = 2.34; 95% confidence interval [CI]: 1.10, 4.98) among all visits and telemedicine-eligible visits (aOR = 2.40; 95% CI: 1.09, 5.27). In 20 patient interviews, patients reported choosing telephone visits when the reason for the visit was perceived as less serious or if they had competing obligations. Discussion: Inconsistent with prior literature, we found higher no-show rates for phone visits, potentially because phone visits are chosen by patients who view their visit as lower priority. More research is needed to understand how telemedicine impacts disparities in prenatal care.

Background: Patients with opioid use disorder (OUD) represent a high-risk population due to increased rates of adverse health outcomes and death. To evaluate whether telehealth utilization during OUD treatment compared with in-person encounters alone was associated with emergency department (ED) utilization, inpatient admissions, and mortality within three years of initiating buprenorphine. Methods: We conducted a retrospective cohort study within the Veterans Health Administration among Veterans treated for OUD between 2012 and -2022. The primary exposure was modality of care, characterized as telehealth encounters (with or without an in-person visit) compared with in-person visits only. Outcomes included an ED visit, inpatient admission, or mortality within three years of the index buprenorphine prescription. We measured the association between each type of treatment modality and outcomes through Cox proportional hazards regression modeling, adjusting for demographic and clinical covariates and confounders. Findings: Of the 57,021 Veterans diagnosed with OUD and who initiated buprenorphine, 38,072 Veterans met study eligibility criteria. The majority of Veterans were male, non-Hispanic White, 25-44 years of age, and lived in urban areas. Approximately 60% of this entire cohort experienced at least one ED visit, 40% experienced an inpatient admission, and 8% died during follow-up. Telehealth use compared with in-person visits only was associated with reduced ED visits (adjusted hazard ratio [aHR] 0.81; 95% confidence interval [CI] 0.77-0.85), inpatient admissions (aHR: 0.71; 95% CI: 0.67-0.76), and mortality (aHR: 0.80; 95% CI: 0.67-0.94). Conclusions: Telehealth may help overcome barriers to in-person care. During buprenorphine treatment for OUD, telehealth as a point of contact with providers and the health care system may reduce more adverse health outcomes, potentially through improving treatment retention. Qualitative studies may help shed light on the mechanisms through which telehealth directly impacts clinical outcomes.

Objective: This study aims to determine how obstetrician-gynecologists provided telehealth from January 2020 to December 2022 in the United States, using de-identified commercial insurance data from FAIR Health. It also explores the trends in telehealth provision by physicians' age, gender, and by state policies on telehealth payment parity. Methods: Aggregated, de-identified data derived from medical claims containing 450,588 physician-quarter observations during 2020 to 2022 were analyzed using descriptive methods to examine the total number of telehealth services to pregnant individuals provided, the number of obstetrician-gynecologists that provided telehealth, and the mean number of telehealth services provided per quarter. Results: Obstetrician-gynecologists' telehealth provision increased rapidly after the onset of the COVID-19 pandemic, reaching its peak during the winter 2020 wave (fourth quarter) during which 4,663 obstetrician-gynecologists provided 13,846 telehealth visits. This was followed by a drop in subsequent quarters and during the fourth quarter of 2022, about 9,500 visits were provided by 2,800 obstetrician-gynecologists. Mean number of telehealth visits per physician was higher among older obstetrician-gynecologists and among those that practiced in states that adapted telehealth payment parity policies. Conclusions: Physician sex, age, and the state of practice location impacted their telehealth provision during the COVID-19 pandemic. Future policies aimed at ensuring telehealth access for pregnant people should consider these factors.