背景:远程医疗已证明其在缓解不同地区医疗资源不平衡分布方面的潜力。河南,中国一个人口约一亿的省份,尤其受到医疗保健鸿沟的影响。该省采取了积极措施,建立了由省级顶级医院提供远程医疗服务的区域协作平台。
目的:确定影响河南省远程医疗服务的运行和有效性的关键因素。从这项研究中获得的见解将为提高低收入和中等收入地区远程医疗平台的有效运行提供有价值的参考。
方法:分析河南省2020年远程医疗服务绩效管理系统的服务报告。使用描述性统计和图形方法,我们研究了关键影响因素,例如管理能力;设备配置;和医院能力,容量,和服务效能,在两个不同层次的医院。此外,我们使用广义线性模型和多元线性回归模型来识别显著影响2种主要远程医疗服务的服务量和疗效的关键操作因素,即远程会诊和远程教育。
结果:在连接到协作远程医疗平台的89家三级医院和97家二级医院中,65(73%)和55(57%),分别,建立了远程医疗服务的标准化管理程序。作为远程医疗服务的主要交付方式,90%(80/89)的三级医院和94%(91/97)的二级医院通过专业硬件终端而不是通用计算机进行视频会议咨询。远程会诊是主要的服务类型,每个机构平均每年为三级和二级医院提供173次(IQR37-372)和60次(IQR14-271)远程会诊的服务量,分别。影响每家医院服务量的关键因素包括可用资金,管理能力,连接的上层的数量,以及专业人员的数量。在接受三级医院(65/89,73%)和二级医院(61/97,63%)的远程会诊后,患者报告其医疗状况显著改善.此外,我们观察到服务效能受管理能力的正向影响,财政激励,连接的上层或下层的数量,以及参与的医疗专业人员的参与。
结论:远程医疗在河南省日益普及,以远程会诊和远程教育服务为重点。尽管它很受欢迎,许多医疗机构,尤其是二级医院,面临与管理能力相关的挑战。除了提升现有远程医疗服务的成效外,河南省和其他中低收入地区的医疗决策者应考虑扩大服务类别,例如包括远程紧急护理和远程手术,有希望解决这些地区的关键医疗保健需求。
BACKGROUND: Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in
China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals.
OBJECTIVE: We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions.
METHODS: We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education.
RESULTS: Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals.
CONCLUSIONS: Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions.