Telemedicine reports最新文献

Aim: This study aimed to evaluate the performance of machine learning (ML) models in predicting patient no-shows for telemedicine appointments within Peruvian health system and identify key predictors of nonattendance.

Methods: We performed a retrospective observational study using anonymized data (June 2019-November 2023) from "Teleatiendo." The dataset included over 1.5 million completed appointments and about 64,000 no-shows (4.1%), focusing on teleorientation and telemonitoring. Predictor variables included patient demographics, socioeconomic factors, health care facility characteristics, appointment timing, and telemedicine service types. A 70% training, 10% validation, and 20% testing split were used over 10 iterations, with hyperparameter tuning performed on the validation set to identify optimal model parameters. Multiple ML approaches-random forest, XGBoost, LightGBM, and anomaly detection-were implemented in combination with undersampling and cost-sensitive learning to address class imbalance. Performance was evaluated using precision, recall, specificity, area under the curve (AUC), F1-score, and accuracy.

Results: Of the models tested, undersampling with XGBoost achieved a precision of 0.115 (±0.001), recall of 0.654 (±0.005), specificity of 0.786 (±0.002), AUC of 0.720 (±0.002), and accuracy of 0.780 (±0.002). In contrast, cost-sensitive XGBoost exhibited a balanced performance with a precision of 0.123 (±0.001), recall of 0.639 (±0.006), specificity of 0.805 (±0.004), AUC of 0.722 (±0.001), and accuracy of 0.799 (±0.003). Additionally, cost-sensitive random forest achieved the highest specificity (0.843 ± 0.002) and accuracy (0.832 ± 0.001) but recorded a lower recall (0.585 ± 0.004), while cost-sensitive LightGBM and balanced random forest yielded performance metrics similar to cost-sensitive XGBoost. Isolation forest, used for abnormality detection, demonstrated the lowest performance.

Conclusions: ML models can moderately predict telemedicine no-shows in Peru, with cost-sensitive boosting techniques enhancing the identification of high-risk patients. Key predictors reflect both individual behavior and system-level contexts, suggesting the need for tailored, context-specific interventions. These findings can inform targeted strategies to optimize telemedicine, improve appointment adherence, and promote equitable health care access.

Background: Teledentistry integrates digital telecommunication technology with dentistry to enhance the quality, accessibility, and cost-effectiveness of dental care, particularly in remote areas. It improves operational efficiency and access to care, especially for pediatric dental patients.

Objective: This study aims to assess the awareness and perceptions of teledentistry among dentists managing pediatric patients in the government sector in Kuwait.

Methods: A descriptive, cross-sectional study was conducted using a self-administered questionnaire to evaluate awareness and perceptions across three domains: the usefulness of teledentistry for patients and dental practice, its potential to improve practice, and concerns regarding its implementation.

Results: A total of 106 responses were received, yielding a 26.7% response rate. Approximately 48% of respondents expressed concerns regarding the reliability of teledental equipment, patient confidentiality, and obtaining informed consent, as well as the security of sending data online. Despite these concerns, 75% of respondents acknowledged the importance of teledentistry in enhancing dental practice. More than half 56% were unaware of the legal implications of teledentistry in Kuwait. Additionally, over 50% recognized the benefits of teledentistry in clinical training, cost reduction, and time-saving. Respondents also supported the integration of teledentistry into dental education and appointment scheduling.

Conclusion: The study found that pediatric dentists in Kuwait exhibit a high level of awareness and positive perception of teledentistry's potential to improve dental practice, despite concerns about its technological and legal implications.

Objective: To examine the transition to telemental health within the behavioral health program of a large federally qualified health center, The Family Health Centers at NYU Langone, in the 3 months following the onset of the COVID-19 pandemic-specifically impacts on show rates and access to care.

Methods: Demographic and clinical information for all scheduled visits was collected for two time periods: the telemental health period, March 16, 2020-July 16, 2020 (46,878 visits, 5,183 patients), and a comparison period, March 15, 2019-July 16, 2019 (47,335 visits, 5,190 patients). Data collected included modality, appointments scheduled/completed/cancelled/no-showed, age, gender, race, language, and diagnosis. Generalized estimating equations with a compound symmetry correlation structure and logit link were used for analysis.

Results: An ∼twofold increase in the likelihood of completing a visit in 2020 vs. 2019 (adjusted OR = 1.92, p < 0.001) was observed. Patients who received treatment in both time frames (n = 2,961) also showed increased completion rates in 2020 vs. 2019. No diagnostic group had a decline in competition rate from 2019 to 2020, including those with severe mental illnesses, although patients with schizophrenia were significantly less likely to complete an initial visit in 2020 compared with 2019 (adjusted odds ratio, aOR = 0.37, p < 0.001). For those with appointments in both timeframes, we noted a significant association between gender and completion rate in 2019 (male 66.5% ± 25.1% vs. female 64.2% ± 24.4%, ANOVA p = 0.01), which was eliminated by implementation of telemental health.

Conclusions: This study supports the use telemental health to increase access for all patients, including those from under-represented, lower socioeconomic status backgrounds.

Background: With the growing adoption of telehealth in allied health disciplines, establishing clear training and education standards is crucial. This review aims to map the current training and education that has been delivered to support development of telehealth competencies in allied health professionals. This scoping review extends our previous review with an updated search.

Methods: The Population Concept Context framework was used, and the following databases were searched: MEDLINE, CINAHL, PsychInfo, Cochrane, EMBASE, Web of Science, PEDro, United Kingdom Health Forum, WHO, Health Education England, and all U.K. and Australian Allied Health Profession (AHP) professional bodies.

Results: Out of 1,05,980 articles, 12 met the inclusion criteria. Training and education differed greatly, with no definite pattern in teaching approaches. Three articles used standardized questionnaires for training and education assessment, while the remaining articles used author-designed assessments. Eight articles reported that participants achieved the targeted telehealth competencies, and five reported improved attitudes toward telehealth following training and education. Articles recommended various factors that may improve telehealth training and education outcomes, which included a combination of online and face-to-face methods, interprofessional training, consolidation of their skills through supervised clinical work, and separating video and telehealth competencies.

Discussion: This scoping review represents the first comprehensive exploration of telehealth training and education across allied health disciplines. While articles yielded generally positive outcomes, the absence of standardized methods prompts questions about its efficacy. Research should focus on developing evidence-based curriculums informed by pedagogic practices tailored to allied health needs.

Introduction: The Web- and Android-based Telemedicine Platform (WATP) is a digital tool designed to facilitate remote medical consultation and data exchange through mobile devices. It addresses health care gaps in underserved rural regions, such as Ecuador, where access to specialized care is limited. This study validated the platform in the Ecuadorian context, focusing on its use in rural clinical settings and its potential integration into academic and health care institutions as a scalable solution for nationwide implementation.

Materials and methods: A mixed-methods approach was used, including technical, clinical, and educational validation. Technical validation involved 10 general practitioners and five specialists who evaluated task completion times, error rates, and user satisfaction. Clinical validation analyzed three teleconsultations, one pediatric and two dermatological, conducted between October 2022 and December 2023, with a focus on diagnostic precision and case clarity. The educational validation involved 17 final-year medical students, 2 faculty members, and 2 observers in a gynecology course in a simulation center to evaluate its impact on learning outcomes.

Results: Technical validation demonstrated low error rates, high user satisfaction, and average task completion times of 5 min for general practitioners and 3 min for specialists. Clinical validation achieved 100% diagnostic accuracy through cross-validation with five independent specialists. Educational validation showed significant improvements in the students' diagnostic skills and clinical case documentation abilities.

Conclusion: This study highlights the potential of WATP to improve health care access and enhance diagnostic skills among medical students, offering a scalable solution tailored to rural challenges in Ecuador.

Introduction: Increased use of telehealth technology during the COVID-19 pandemic helped reduce the impact of some barriers to health care access (e.g., geographical distance) while amplifying the negative impact of others (e.g., poor internet availability). This quality improvement project evaluated a program established at a specialized hospital for children and adolescents with neurodevelopmental disabilities to improve access of patients and families to technologies necessary for telehealth-based care.

Methods: Our telehealth access and device distribution program utilized Federal Communications Commission funding to distribute 336 iPads and 279 Wi-Fi hotspots to 414 patients recommended for the program by their clinicians. An average of 1.6 years later, participants received a satisfaction survey via text or email.

Results: The referred patient cohort had higher economic disadvantage (average Area Deprivation Index = 7.67) and more language diversity (16% Spanish) compared with hospital averages. About 27% (n = 112) of caregivers completed the satisfaction survey. Most respondents, including 92% of Spanish speakers, reported receiving instructions in their preferred language. Approximately 80% of caregivers stated that the devices enabled telehealth visits. Notably, device abandonment/disuse was considerable, with only 63% of iPads and 36% of Wi-Fi hotspots still in use an average of 1.6 years after device distribution.

Discussion: Program efforts were largely successful in facilitating telehealth access via the dissemination of iPads and Wi-Fi hotspots to a patient subpopulation with economic disadvantage and language differences. Follow-up feedback from participants suggests that additional check-ins and device monitoring may be necessary to prevent device abandonment/disuse and maintain longevity of telehealth access.

Background: Increasing intensivist shortages and demand, coupled with the escalating bed occupancy rate due to increased demand for neonatal intensive care units (NICUs), have created enthusiasm for tele-critical care (TCC) in the form of teleconsultations. Consequently, this study aimed to describe the role of TCC intervention in enhancing NICU capacity to manage discharge, bed occupancy, and neonatal mortality rates.

Methods: This was an uncontrolled, retrospective, interventional descriptive study conducted over 22 months from January 2021 to October 2022 in a public hospital in Najran, Saudi Arabia. We employed the scheduled care model of TCC, in which an intensivist provides daily rounds, overnight calls, and critical care consultations upon request. Real-time outcomes, including mortality, discharge, and bed occupancy rates, were monitored in real-time by the National Healthcare Command Center.

Results: Implementing the TCC program was associated with an overall reduction of 10.7% in the neonatal mortality rate from 10.3 to 9.2 deaths per 1000 live births. The discharge rate increased from 0% in the early months of the TCC application to 34.12% after 4 months of application despite the increased bed occupancy rate. The study revealed no statistically significant difference in mortality rates between the means of pre- and post-TCC (M = 9.74, SD = 4.32), (M = 10.28, SD = 7.99) respectively, p = 0.856 with a 95% confidence interval of -5.58 to 6.66.

Conclusions: TCC in virtual scheduled consultations with a real-time dashboard was proven successful in controlling neonatal mortality and discharge rates. Further studies are required with extended follow-up periods and involving parameters such as the acceptance of physicians, long-term effects beyond the NICU, and the impact of TCC on logistics and resources.

Background: Advancing digital health requires a realistic conversation that moves past innovation and evaluates digital tools the same as any other device being introduced into the health system. There needs to be a focus on return on investment.

Methods: As part of a symposium, we presented hypothetical pitches to an expert panel. The experts include representatives from health systems, payers, and investors. The pitches were related to remote patient monitoring, tele-triage in the emergency department, and comprehensive in-patient telemedicine program including virtual sitting and e-nursing.

Results: Although each pitch led to a different discussion, there was uniform agreement that health systems should focus on whether the proposal helps solve an institutional problem; the payment model in which the product can be used (value-based, fee-for-service, or both) needs to be identified; fitting the new product into preexisting workflow (included electronic health system integration) is critical; there needs to be an understanding of whether patients and providers engage with it; and there needs to be a clear return on investment.

Discussion: Navigating complex decision-making in health care requires a blend of strategic foresight, practical considerations, and a deep understanding of organizational dynamics. Rather than a specific strategic plan focused on digital or virtual care, there should be a focus on the enterprise strategic plan and how can digital enable that.

Background: The emergency department (ED) provides a significant portion of health care services in the United States, and its utilization has increased over the past decade. ED overcrowding remains a considerable challenge to many EDs. The objectives of this study were (1) to evaluate the knowledge of telehealth and readiness to use it among patients who visit EDs in a nonurgent triage category and (2) to estimate their willingness-to-use and willingness-to-pay for telehealth consultations.

Methods: A structured questionnaire was administered using a tablet to adult patients who visited the ED of a large medical center and who were triaged into a nonurgent category. Respondents were asked about their sociodemographic and ED visit characteristics and health and telehealth utilization history. Then, we presented them with a hypothetical scenario for visiting a board-certified ED doctor through telehealth instead of in-person visits, and, using a double-bound dichotomous choice iterative bidding algorithm, we solicited their willingness-to-pay for such a telehealth visit.

Results: A total of 171 patients agreed to participate in the study. More than half of the respondents (n = 107; 62.6%) said they have health insurance. Almost half of the respondents (n = 71; 41.5%) reported the main reason for going to the ED was an ongoing condition or concern. More than two-thirds of the respondents identified themselves as being very proficient with using a smartphone or tablet (n = 116; 67.8%), and only a few (n = 21; 12.3%) reported not having any internet-capable device. Most respondents (n = 148; 86.5%) had never heard about telehealth. However, after a brief description of telehealth, we found that approximately two-thirds of the patients would be willing to use or consider using telehealth (n = 107; 62.6%), and one-third (n = 64; 37.4%) would not be interested. We did not observe any statistically significant differences in willingness-to-use. However, we observed statistically significant differences in the willingness-to-pay $50 by gender (p < 0.01), by currently having a regular doctor/clinic (p < 0.05), and by health insurance status.

Conclusions: Hospitals should consider investigating telehealth services that can be provided to their communities as an option instead of visiting their EDs. While technology does not seem to be a barrier to telehealth, more educational initiatives to inform the public about telehealth are desirable. A targeted advertisement campaign to recommend telehealth for nonlife-threatening ED visits could be developed once more user characteristics are collected.

Background: The use of telemedicine can contribute to patient satisfaction, support hygienic concepts by avoiding physical contact when not required, and reduce waiting and travel time. We aimed to evaluate our recently implemented telemedical approach of remote pre-anesthesia assessment.

Methods: We designed a questionnaire to assess patient satisfaction with remote pre-anesthesia assessment procedures, completeness of understanding, and technical feasibility. In total, 250 patients were asked to voluntarily complete the questionnaire after their pre-anesthesia assessment via telephone. Digital anesthesia records were subsequently reviewed for unexpected events and complications to investigate the quality and safety of the approach.

Results: Patients included in our study were 51 years old (median, range 18-85 years), mostly female (58%) and had an American Society of Anesthesiologists (ASA) physical status of 1-3 (22.8%, 56.4%, and 20.8%, respectively). Patient satisfaction was high with ratings of "very good" or "good" in over 90% of all questions related to the pre-anesthesia assessment via telephone. Patient's evaluation for the use of telemedicine in general also showed a wide acceptance with 84.4% rating the idea as "very good" (55.6%) or "good" (28.8%). Duration of patient-physician interaction positively correlated with age (p = 0.005) and ASA status (p = 0.003). Upon review of the digital anesthesia records, there were no intraoperative complications or unexpected events related to the remote pre-anesthesia assessment.

Conclusion: Remote pre-anesthesia assessment via telephone is safe, technically feasible, and satisfactorily accepted in selected patients. These results encourage the continuing implementation of telemedical approaches for pre-anesthesia assessment.