@文章{信息:doi/10.2196/30632，作者="Tsou, Christina和Robinson, Suzanne和Boyd, James和Jamieson, Andrew和Blakeman, Robert和Yeung, Justin和McDonnell, Josephine和Waters, Stephanie和boich, Kylie和Hendrie, Delia"，标题="远程医疗在农村和远程急诊科的有效性:系统评价"，期刊="J Med Internet Res"，年="2021"，月="11"，日="26"，卷="23"，数="11"，页="e30632"，关键词="远程医疗;远程医疗;临床疗效;治疗效果;农村人口;农村卫生;背景:紧急远程医疗已被用于改善居住在农村和偏远地区的患者获得专家护理的机会，以期减轻他们所经历的重大健康差距。农村和偏远地区急诊科的病人处置决定可能很复杂，在很大程度上取决于当地(接收端)医院的专业知识和经验。虽然在农村和偏远急诊科的临床实践中，对于非急性症状的急诊远程医疗的有效性已经有了一些综合证据，但对诸如临床区域和症状敏锐度等背景因素对这些发现的影响的评估有限。目的:本系统综述的目的是检查用于研究农村和远程急诊科远程医疗有效性的结局指标，并分析这些结局指标被使用和解释的临床背景。 Methods: The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. Results: A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and---depending on the context---improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. Conclusions: Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. Trial Registration: PROSPERO CRD42019145903; https://tinyurl.com/ndmkr8ry ", issn="1438-8871", doi="10.2196/30632", url="//www.mybigtv.com/2021/11/e30632", url="https://doi.org/10.2196/30632", url="http://www.ncbi.nlm.nih.gov/pubmed/34842537" }