社区神经病学实践中的电子会诊:为最佳实践提供依据的回顾性研究

Nathan A. Seven MD , Karen A. Truitt DO , Ross A. Dierkhising MS , Nathan P. Young DO
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引用次数: 0

摘要

目标描述我们的电子会诊(e-consults)实践,并评估后续面对面会诊的安全性和风险因素。患者和方法对 2018 年 5 月 5 日至 2019 年 6 月 31 日期间在社区神经内科完成的所有电子会诊进行回顾性队列研究。比较了成功组群和不成功组群(以是否存在后续面对面会诊为标准)的临床和人口统计学变量。使用 Cox 回归模型计算危险比(HR)。进行了后续面对面咨询的 Kaplan-Meier 概率分析(含 95% CIs)。对突出潜在危害的案例进行了总结。最常见的转诊病例为头痛(125例,41.4%)、疼痛(40例,13.2%)和影像异常(27例,8.9%)。最常见的电子会诊问题是治疗建议(57.6%)和诊断评估建议(48.0%)。此外,24.8%(n=75)的电子会诊后进行了面对面会诊,主要风险因素包括女性(HR,1.9)、头痛转诊(HR,1.7)、偏头痛最终诊断(HR,2.0)或长期偏头痛(HR,5.0)。6名(2.0%)偏头痛患者和4名(1.3%)无偏头痛患者在急诊科就诊时发现了与诊断/治疗延迟相关的潜在危害。对于慢性偏头痛患者,电子会诊应视为短期行为,一旦条件允许,应立即进行面对面会诊。进行电子会诊的神经科医生应能将患者分流至面对面会诊,尤其是在诊断不确定或神经检查有助于指导适当检查的情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Electronic Consultations in a Community Neurology Practice: A Retrospective Study Informing Best Practice

Objective

To describe our practice of electronic consultations (e-consults) and assess safety and risk factors for subsequent face-to-face consultations.

Patients and Methods

A retrospective cohort study of all e-consults completed in a community neurology practice between May 5, 2018, and June 31, 2019, was completed. Clinical and demographic variables were compared between the successful and unsuccessful (defined by presence of subsequent face-to-face consultation) cohorts. Hazard ratios (HR) were calculated using Cox regression model. Kaplan-Meier probability analysis (with 95% CIs) of subsequent face-to-face consultation was performed. Case examples highlighting potential harm were summarized.

Results

In total, 302 e-consults were reviewed. The most frequent referrals were for headache (n=125, 41.4%), dysesthesia (n=40, 13.2%), and abnormal imaging finding (n=27, 8.9%). The most common e-consult questions were for treatment (57.6%) and diagnostic evaluation (48.0%) recommendations. Moreover, 24.8% (n=75) of e-consults were followed by face-to-face consultations, with primary risk factors including female sex (HR, 1.9), referral for headache (HR, 1.7), and final diagnosis of migraine (HR, 2.0) or long-term migraine (HR, 5.0). Potential harm related to delayed diagnosis/treatment was identified in 6 (2.0%) patients with migraine and 4 (1.3%) without migraine presenting to emergency department.

Conclusion

Utilization of e-consults may safely improve access to neurologic expertise and prevent the need for some visits, which may have required a face-to-face visit. In patients with chronic migraine, e-consults should be considered short-term and followed by face-to-face consultation as soon as access allows. Neurologists performing e-consults should be able to triage patients to face-to-face consultation, particularly when diagnosis is uncertain or the neurologic examination may help guide appropriate testing.

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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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