1
|
Wallace MM, Hackstadt AJ, Zhao Z, Patrinely JR, Zic J, Ellis D, Paul L, Sultan M, Danford B, Hanlon AM. The Teledermatology Experience: Cost Savings and Image Quality Control. Telemed J E Health 2024; 30:1411-1417. [PMID: 38150704 DOI: 10.1089/tmj.2022.0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction: Teledermatology adoption continues to increase, in part, spurred by the COVID-19 pandemic. This study analyzes the utility and cost savings of a store-and-forward teledermatology consultative system within the Veterans Health Administration (VA). Methods: Retrospective cohort of 4,493 patients across 14 remote sites in Tennessee and Kentucky from May 2017 through August 2019. The study measured the agreement between the teledermatology diagnoses and follow-up face-to-face clinic evaluations as well as the cost effectiveness of the teledermatology program over the study period. Results: Fifty-four percent of patients were recommended for face-to-face appointment for biopsy or further evaluation. Most patients, 80.5% received their face-to-face care by a VA dermatologist. There was a high level of concordance between teledermatologist and clinic dermatologist for pre-malignant and malignant cutaneous conditions. Veterans were seen faster at a VA clinic compared with a community dermatology site. Image quality improved as photographers incorporated teledermatologist feedback. From a cost perspective, teledermatology saved the VA system $1,076,000 in community care costs. Discussion: Teledermatology is a useful diagnostic tool within the VA system providing Veteran care at a cost savings.
Collapse
Affiliation(s)
- Matthew M Wallace
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amber J Hackstadt
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Zijun Zhao
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - John Zic
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Darrel Ellis
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lynn Paul
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miliyard Sultan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brandon Danford
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Allison M Hanlon
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
2
|
Calafiore R, Khan A, Anderson D, Wu ZH, Lu J. Impact of dermoscopy-aided pediatric teledermatology program on the accessibility and efficiency of dermatology care at community health centers. J Telemed Telecare 2024; 30:519-526. [PMID: 34962174 DOI: 10.1177/1357633x211068275] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are few studies focusing on pediatric teledermatology, and the impact of a large-scale pediatric teledermatology program on the accessibility and efficiency of dermatology care remains unclear. This study evaluated the impact of a state-wide implementation of a store-and-forward teledermatology program augmented by the incorporation of dermoscopy in pediatric patients visiting community health centers. METHODS It was a descriptive, retrospective cohort study of 876 pediatric dermatology referrals. RESULTS In the traditional referral system, only 60 patients (17.6%) were seen by dermatologists with average waiting times of 75 days due to limited access. In comparison, with an implementation of dermoscopy-aided teledermatology, all 536 teledermatology referrals received dermatological care within 24 h, of which only 64 (12%) patients requires face-to-face (F2F) consultation. Patients referred for F2F consultation via eConsults had a much lower no-show rate as compared to the traditional referral system (39% vs. 71%). Side by side comparison between general population and pediatric population has demonstrated shared features in efficiency and access improvement but revealed specific characteristics of pediatric teledermatology in terms of diagnosis and treatment. CONCLUSION Coordinated store-and-forward teledermatology platform with incorporation of dermoscopy between large community care network and dermatology provider can greatly improve access to pediatric dermatology care especially in underserved population. The efficiency of teledermatology in access improvement for pediatric population is comparable with adult population in eConsults. There are also unique features and challenges in pediatric teledermatology that require further research.
Collapse
Affiliation(s)
| | - Aziz Khan
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Daren Anderson
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Zhao Helen Wu
- Weitzman Institute & Community Health Center, Inc., Middletown, CT, USA
| | - Jun Lu
- University of Connecticut School of Medicine, Farmington, CT, USA
| |
Collapse
|
3
|
Shapiro J, Lavi IK, Kun D, Ingber A, Freud T, Grunfeld O. Does the Diagnostic Accuracy and Rates of Face-to-Face Visits Occurring Shortly after an Asynchronized Teledermatology Consultation Justify Its Implementation? An 18-Month Cohort Study. Dermatology 2024; 240:425-433. [PMID: 38522421 DOI: 10.1159/000537823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/11/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION In 2019, Maccabi Health Services (MHS) rolled out the store-and-forward "Dermadetect" teledermatology consultation (TC) application. Study goal was to analyze MHS records of TCs (August 2019-February 2021) for the rate and reasons for face-to-face consultations (FTFC) occurring shortly after a TC with emphasis on FTFCs resulting in a different diagnosis for the same indication. METHODS The records of FTFCs held up shortly after TCs were reviewed and classified into cases marked as unsuited for teledermatology, cases in which the indication differed, and cases with the same indication, which were analyzed for concordance of diagnoses. RESULTS Dermadetect was used by 12,815 MHS beneficiaries. In 30% of cases, following FTFC occurred within the subsequent 5 months, and 901 of them occurred in the subsequent 2 weeks and were analyzed. Thirty percent were not suited for teledermatology, 15% were held for a different indication, and 55% occurred for the same indication. The diagnosis concordance between the TC and recurrent FTFC for the same indication was 97.4%, with full concordance at 68.1% and partial concordance at 29.3%. Overall, 13 patients (1.4%) of the 901 patients using the application only once had a subsequent FTFC within 2 weeks and received a different diagnosis than the one given in the TC. CONCLUSIONS When considering the implementation of store-and-forward TC's, a 30% rate of following FTFC's during the next 5 months should be considered when planning the reimbursement model. Diagnosis discordance may be disregarded due to its low rates.
Collapse
Affiliation(s)
| | | | - Daniel Kun
- Maccabi Healthcare Services, Ramat Hasharon, Israel
| | - Arieh Ingber
- Department of Dermatology, Hadassah University Hospital, Jerusalem, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, Department of Family Medicine, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | |
Collapse
|
4
|
Teledermatology in Rural, Underserved, and Isolated Environments: A Review. CURRENT DERMATOLOGY REPORTS 2022; 11:328-335. [PMID: 36310767 PMCID: PMC9589860 DOI: 10.1007/s13671-022-00377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
Purpose of Review Recent Findings Summary
Collapse
|
5
|
Abstract
Purpose of Review The use of teledermatology has been evolving slowly for the delivery of health care to remote and underserved populations. Improving technology and the recent COVID-19 pandemic have hastened its use internationally. Recent Findings Some barriers to the use of teledermatology have fallen considerably in the last year. Summary Teledermatology use has increased significantly in recent years in both government-sponsored and private health care systems and individual practices. There are no recognized international practice guidelines and variable use within countries. Many barriers remain to increasing the use of teledermatology.
Collapse
|
6
|
Rea CJ, Delano S, Hawryluk EB, Rosen M, Tran KD, Pearl M, Pethe K, Toomey SL. An Innovative Model for Providing Dermatology Services Within Primary Care. Acad Pediatr 2020; 21:723-727. [PMID: 33068810 PMCID: PMC7557161 DOI: 10.1016/j.acap.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Dermatologic complaints are common in outpatient pediatrics. However, pediatric dermatology specialty care can be difficult to access. We aimed to test the feasibility of co-locating dermatology services within primary care and increase the proportion of patients treated for basic skin complaints within the medical home while decreasing wait times. METHODS The Rapid Assessment of Skin Health (RASH) clinic was created within a hospital-based primary care clinic in 11/2013. The clinic was staffed by 2 pediatricians trained in the dermatology department and supported with specialist advice as needed. Referral volume and wait times to dermatology and RASH clinic were tracked for visits between 11/1/12 and 10/31/18. A chart review was also conducted on a subset of RASH clinic visits. Primary care providers (PCPs) were surveyed about their experiences. RESULTS Fifty-eight percent of patients referred for a dermatologic complaint were scheduled in RASH clinic. Wait times for new patient appointments in RASH clinic were significantly shorter than for new dermatology appointments in the previous 12 months (mean 36 days vs 65 days, P < .001). The monthly number of referrals to dermatology also decreased significantly after the RASH clinic opened (24/month vs 12/month, P < .001). Ten percent of RASH patients were referred on to dermatology. In a survey of PCPs (N = 67), 76% said the RASH clinic was "extremely/very helpful." CONCLUSIONS Providing dermatologic care to low or moderate complexity patients within the medical home is feasible and leads to better access to care. This innovative model could be spread to other clinics and subspecialties.
Collapse
Affiliation(s)
- Corinna J. Rea
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Address correspondence to Corinna J. Rea, MD, MPH, Division of General Pediatrics, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Ave, Boston, MA 02115
| | - Sophia Delano
- Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Dermatology Program, Division of Allergy and Immunology, Boston Children's Hospital (S Delano and EB Hawryluk), Boston, Mass
| | - Elena B. Hawryluk
- Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Dermatology Program, Division of Allergy and Immunology, Boston Children's Hospital (S Delano and EB Hawryluk), Boston, Mass,Department of Dermatology, Massachusetts General Hospital (EB Hawryluk), Boston, Mass. Dr Pethe is now with Department of Pediatrics, Columbia University Medical Center-Vagelos College of Physicians and Surgeons, New York, NY and also with NewYork-Presbyterian Hospital, New York, NY
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| | - Katherine D. Tran
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| | - Maria Pearl
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| | - Kalpana Pethe
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| | - Sara L. Toomey
- Division of General Pediatrics, Boston Children's Hospital (CJ Rea, M Rosen, KD Tran, M Pearl, K Pethe, and SL Toomey), Boston, Mass,Harvard Medical School (CJ Rea, S Delano, EB Hawryluk, M Pearl, K Pethe, and SL Toomey), Boston, Mass
| |
Collapse
|
7
|
Peracca SB, Jackson GL, Lamkin RP, Mohr DC, Zhao M, Lachica O, Prentice JC, Grenga AM, Gifford A, Chapman JG, Weinstock MA, Oh DH. Implementing Teledermatology for Rural Veterans: An Evaluation Using the RE-AIM Framework. Telemed J E Health 2020; 27:218-226. [PMID: 32343924 DOI: 10.1089/tmj.2020.0013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: Few systematic evaluations of implementing teledermatology programs in large health care systems exist. We conducted a longitudinal evaluation of a U.S. Department of Veterans Affairs (VA) initiative to expand asynchronous consultative teledermatology services for rural veterans. Methods: The reach, effectiveness, adoption, implementation, and maintenance framework guided the evaluation, which included analysis of quantitative VA administrative data as well as an online survey completed by participating facilities. The first 2 years of the program were compared with the year before the start of funding. Results: Sixteen hub facilities expanded teledermatology's reach over the 2-year period, increasing the number of referral spoke sites, unique patients served, and teledermatology encounters. Effectiveness was reflected as teledermatology constituted an increasing fraction of dermatology activity and served more remotely located patients. Adoption through defined stages of implementation progressed as facilities engaged in a variety of strategies to enhance teledermatology implementation, and facilitators and barriers were identified. Program maintenance was assessed by Program Sustainability Index scores, which reflected the importance of executive support, and ongoing concerns about staffing and longitudinal funding. Discussion: Enabling hubs to create solutions that best fit their needs and culture likely increased reach and effectiveness. Important facilitators included organizational leadership and encouraging communication between stakeholders before and during the intervention. Conclusions: A systematic analysis of teledermatology implementation to serve rural sites in VA documented a high degree of implementation and sustainability as well as areas for improvement.
Collapse
Affiliation(s)
- Sara B Peracca
- Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Department of Population Health Sciences and Division of General Internal Medicine, Department of Medicine, Duke University, North Carolina, USA
| | - Rebecca P Lamkin
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Molly Zhao
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
| | - Olevie Lachica
- Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Julia C Prentice
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, School of Medicine, Boston University, Massachusetts, USA
| | | | - Allen Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
| | - Jennifer G Chapman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Martin A Weinstock
- Providence VA Medical Center, Providence, Rhode Island.,Office of Connected Care, Veterans Health Administration, Washington, District of Columbia, USA.,Dermatoepidemiology Unit, Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Dennis H Oh
- Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Office of Connected Care, Veterans Health Administration, Washington, District of Columbia, USA.,Department of Dermatology, University of California at San Francisco, San Francisco, California, USA
| |
Collapse
|