Effectiveness and efficiency of tele-expertise for improving access to retinopathy screening among 351 neonates in a secondary care center: An observational, controlled before-after study.

Autor: Moitry M; Laboratoire d'Épidémiologie et de Santé Publique, Strasbourg, France.; Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Zarca K; Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France.; Assistance Publique-Hôpitaux de Paris, service de santé publique, Henri Mondor-Albert- Chenevier, Créteil, France., Granier M; Service de réanimation néonatale, Hôpitaux Sud Francilien, Evry, France., Aubelle MS; Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France.; DHU Risques et grossesse, Université Paris Descartes, Paris, France., Charrier N; USRC, Centre Hospitalier René Dubos, Pontoise, France., Vacherot B; Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France., Caputo G; Service d'ophtalmologie pédiatrique, Fondation Rothschild, Paris, France., Mimouni M; Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France., Jarreau PH; Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France.; DHU Risques et grossesse, Université Paris Descartes, Paris, France., Durand-Zaleski I; Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France.; Assistance Publique-Hôpitaux de Paris, service de santé publique, Henri Mondor-Albert- Chenevier, Créteil, France.; Faculté de Médecine, Université Paris-Est & ECEVE UMRS, Créteil, France.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2018 Oct 26; Vol. 13 (10), pp. e0206375. Date of Electronic Publication: 2018 Oct 26 (Print Publication: 2018).
DOI: 10.1371/journal.pone.0206375
Abstrakt: In France, secondary care hospitals encounter difficulties to adhere to retinopathy of prematurity (ROP) screening guidelines. Our objective was to assess the effectiveness and efficacy of a tele-expertise program for ROP screening in neonatal intensive care units without on-site ophthalmologists. We evaluated the impact of a tele-expertise program funded by the Paris Region Health Authority in a secondary care center general hospital of the Paris Region (CHSF), where there was previously no on-site ophthalmologist. We performed an observational, controlled before-after study, with a university tertiary care center with on-site ophthalmologists (Port-Royal) as the control group. Recruitment and data collection for both periods took place from 1 January 2012 to 31 December 31 2012, and from 1 January 2014 to 31 March 2015. The primary endpoint was the percentage of compliance with screening guidelines, secondary endpoints included pain scores and costs. Over the two periods, at total of 351 infants were recruited in the CHSF. Implementation of the tele-expertise resulted in an absolute +57.3% increase in the proportion of examinations realized in accordance with guidelines (3.8% during the "before" period and 61.1% during the "after" period, p<0.001). As compared with the control group, the proportion of infants appropriately screened improved (57.5% versus 43.1%, p = 0.002); median pain score on the acute pain rating scale for neonates during examination was significantly higher (median score 5.5/10, range [2.5-5.7] versus 2.0/10, range [1.0-3.1], p = 0.002). Screening rates in the control group remained unchanged. The average cost per examination increased from €337 in the "before" period to €353 in the "after period" in the tele-expertise group. The implementation of tele-expertise for ROP screening in the CHSF medical center resulted in a major improvement of access to care with a small cost increase. The issue of pain control during examination with tele-expertise should be further addressed.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje