Background: The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. Objective: The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. Methods: We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. Results: Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. Conclusions: In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.

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中文翻译：

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接受COVID-19的患者的院内远程医疗计划评估：混合方法研究

背景：COVID-19感染的发生率不断上升，已经向医疗保健系统提出了挑战，要求它们在提高容量的同时，还要保护个人防护设备（PPE）的用品并最大程度地减少医院内的传播。远程医疗显示出有望解决这些挑战，但在住院环境中缺乏全面的评估。目的：本研究的目的是评估医院内远程医疗计划（虚拟护理）及其对接触风险和沟通的影响。方法：我们对接受COVID-19的患者进行了虚拟护理的自然实验。主要暴露变量已记录为使用虚拟护理。评估患者的特征，个人防护装备的使用率及其与虚拟护理的相关性。在平行下，我们对患者和临床医生进行了调查，以了解在沟通，医疗和接触风险领域对虚拟护理的满意度。结果：在我们的主要分析中，共有137名患者中，有43名患者使用了虚拟护理。总共有82天的住院使用日和401天的未使用住院日。选择入院与选择出院的患者的医院利用率和疾病严重程度相似。虚拟护理与PPE使用和体检率的显着降低有关。对41位患者和临床医生的调查显示，对于进一步使用的建议率很高，并且在交流方面具有主观的改善。但是，提供者和患者在可用性，医学评估和移情交流方面表现出局限性。结论：在这个自然试验中，只有一部分患者使用了住院虚拟护理。使用虚拟护理时，可以减少PPE使用量，减少暴露风险以及患者和医疗服务提供者的满意度。

这仅仅是抽象的。阅读JMIR网站上的全文。JMIR是互联网时代电子健康和医疗保健领域领先的开放获取期刊。