COVID-19大流行和身体距离的需要导致了虚拟就诊的迅速吸收,以提供动态医疗保健。尽管广泛采用,对于门诊护理敏感病症(ACSC),通过虚拟模式提供的护理质量评价有限.
描述患者和提供者对ACSCs虚拟护理质量和可持续性的体验。
这是一项多方法研究,利用来自患者调查的定量和定性数据,提供者调查,2020年5月至2021年6月期间,一家大型学术门诊护理医院的提供者焦点小组。我们纳入了使用电话或视频访问以下ACSC的患者和提供者:高血压,心绞痛,心力衰竭,心房颤动,糖尿病,慢性阻塞性肺疾病,或者哮喘.
定量和定性的患者和提供者调查响应被映射到医疗保健质量框架的六个领域。对提供者焦点组进行编码以识别每个质量域内的主题。
调查由110/352(31%)同意的患者和20/61(33%)提供者完成。有14名参与者举行了5个提供者焦点小组。患者发现虚拟访问通常比ACSC的亲自访问更方便。虚拟访问的感知有效性取决于个人遇到的临床和社会复杂性。受访者报告说,在虚拟环境中难以形成有效的患者-提供者关系。患者和提供者认为,虚拟护理有可能减轻和加剧公平获得护理的结构性障碍。
在一家大型学术门诊护理医院,患者和提供者经历的ACSCs管理的虚拟访视质量取决于个体遭遇的生物心理社会复杂性.我们在每个质量领域的发现都突出了患者的关键考虑因素,提供者和机构维护ACSC的虚拟护理质量。
The COVID-19 pandemic and the need for physical distancing has led to rapid uptake of virtual visits to deliver ambulatory health care. Despite widespread adoption, there has been limited evaluation of the quality of care being delivered through virtual modalities for ambulatory care sensitive conditions (ACSCs).
To characterize patients\' and providers\' experiences with the quality and sustainability of virtual care for ACSCs.
This was a multi-method study utilizing quantitative and qualitative data from patient surveys, provider surveys, and provider focus groups at a large academic ambulatory care hospital between May 2020 and June 2021. We included patients and providers utilizing telephone or video visits for the following ACSCs: hypertension, angina, heart failure, atrial fibrillation, diabetes, chronic obstructive pulmonary disease, or asthma.
Quantitative and qualitative patient and provider survey responses were mapped to the Six Domains of Healthcare Quality framework. Provider focus groups were coded to identify themes within each quality domain.
Surveys were completed by 110/352 (31%) consenting patients and 20/61 (33%) providers. 5 provider focus groups were held with 14 participants. Patients found virtual visits to be generally more convenient than in-person visits for ACSCs. The perceived effectiveness of virtual visits was dependent on the clinical and social complexity of individual encounters. Respondents reported difficulty forming effective patient-provider relationships in the virtual environment. Patients and providers felt that virtual care has potential to both alleviate and exacerbate structural barriers to equitable access to care.
In a large academic ambulatory care hospital, patients and providers experienced the quality of virtual visits for the management of ACSCs to be variable depending on the biopsychosocial complexity of the individual encounter. Our findings in each quality domain highlight key considerations for patients, providers and institutions to uphold the quality of virtual care for ACSCs.