Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia.
JAMA Dermatol. 2014 Apr;150(4):419-24. doi: 10.1001/jamadermatol.2013.9517.
Many hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency, thereby expanding access to specialized care for hospitalized patients.
To evaluate whether a store-and-forward teledermatology system is reliable for the initial triage of inpatient dermatology consultations.
DESIGN, SETTING, AND PARTICIPANTS: Prospective study of 50 consenting adult patients, hospitalized for any indication, for whom an inpatient dermatology consultation was requested between September 1, 2012, and April 31, 2013, at the Hospital of the University of Pennsylvania, an academic medical center. The participants were evaluated separately by both an in-person dermatologist and 2 independent teledermatologists.
The primary study outcomes were the initial triage and decision to biopsy concordance between in-person and teledermatology evaluations.
Triage decisions were as follows: if the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist. The Kendall τ rank correlation coefficients for initial triage concordance between the in-person dermatologist and teledermatologists were 0.41 and 0.48. The Cohen κ coefficients for decision to biopsy concordance were 0.35 and 0.61. The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge.
Teledermatology is reliable for the triage of inpatient dermatology consultations and has the potential to improve efficiency.
许多医院没有住院皮肤科会诊服务，而且大多数医院在非工作时间都减少了服务的可获得性。基于门诊的皮肤科医生可能难以确定他们需要多快评估请求会诊的住院患者的紧迫性。远程皮肤病学可能为皮肤科医生提供一种有价值的机制，用于分诊住院会诊并提高效率，从而为住院患者提供更多获得专业护理的机会。
评估存储转发远程皮肤病学系统是否可用于住院皮肤科会诊的初步分诊。
设计、地点和参与者：这是一项前瞻性研究，纳入了 2012 年 9 月 1 日至 2013 年 4 月 31 日期间因任何原因住院并请求住院皮肤科会诊的 50 名同意的成年患者。这些参与者分别由一名现场皮肤科医生和 2 名独立的远程皮肤科医生进行评估。
主要研究结果是现场和远程皮肤病学评估之间的初步分诊和活检决策的一致性。
分诊决策如下：如果现场皮肤科医生建议当天就诊，远程皮肤科医生在 90%的会诊中表示同意。如果现场皮肤科医生建议进行活检，远程皮肤科医生平均有 95%的情况下表示同意。当远程皮肤科医生未选择相同的治疗方案时，远程皮肤科医生和现场皮肤科医生之间存在大量诊断一致性。现场皮肤科医生和远程皮肤科医生之间的初始分诊一致性的 Kendall τ 等级相关系数分别为 0.41 和 0.48。活检决策一致性的 Cohen κ 系数分别为 0.35 和 0.61。远程皮肤科医生能够将 60%的会诊分诊为次日或更晚就诊。远程皮肤科医生平均能够将 10%的患者分诊为出院后门诊就诊。
远程皮肤病学可用于住院皮肤科会诊的分诊，并且有可能提高效率。
