University of North Dakota School of Medicine, Grand Forks, USA.
University of Pittsburgh Medical Center, Pittsburgh, USA.
J Telemed Telecare. 2020 Jan-Feb;26(1-2):92-99. doi: 10.1177/1357633X18797175. Epub 2018 Sep 12.
This manuscript describes data from an original study, simulating a tele-glaucoma programme in an established clinic practice with an interdisciplinary team. This is a ‘real life’ trial of a telemedicine approach to see a follow-up patient. The goal is to evaluate the accuracy of such a programme to detect worsening and/or unstable disease. Such a programme is attractive since in-clinic time could be reduced for both the patient and provider. This study evaluates agreement between in-person and remote assessment of glaucoma progression.
A total of 200 adult glaucoma patients were enrolled at a single institution. The in-person assessment by an optometrist or glaucoma specialist at time of enrolment was used as the gold standard for defining progression. Collated clinical data were then reviewed by four masked providers who classified glaucoma as progression or non-progression in each eye by comparing data from enrolment visit to data from the visit immediately prior to enrolment. Agreement of glaucoma progression between the masked observer and the in-person assessment was determined using Kappa statistics. Intra-observer agreement was calculated using Kappa to compare in-person to remote assessment when both assessments were performed by the same provider (n = 279 eyes).
A total of 399 eyes in 200 subjects were analysed. Agreement between in-person versus remote assessment for the determination of glaucoma progression was 63%, 62%, 69% and 68% for each reader 1–4 (kappa values = 0.19, 0.20, 0.35 and 0.33, respectively). For intra-observer agreement, reader 1 agreed with their own in-person assessment for 65% of visits (kappa = 0.18).
Intra-observer agreement was similar to the agreement for each provider who did not see the patient in person. This similarity suggests that telemedicine may be equally effective at identifying glaucomatous disease progression, regardless of whether the same provider performed both in-clinic and remote assessments. However, fair agreement levels highlight a limitation of using only telemedicine data to determine progression compared with clinical detail available during in-patient assessment.
本手稿描述了一项原始研究的数据，该研究模拟了一个具有跨学科团队的既定诊所实践中的远程青光眼计划。这是一种使用远程医疗方法来随访患者的“真实生活”试验。其目标是评估这种程序检测疾病恶化和/或不稳定的准确性。由于可以减少患者和医生的就诊时间，因此这种方案具有吸引力。本研究评估了面对面评估和远程评估青光眼进展之间的一致性。
在一家单机构共纳入 200 名成年青光眼患者。在招募时由验光师或青光眼专家进行的面对面评估被用作定义进展的金标准。然后，由四名蒙面提供者对汇总的临床数据进行了回顾，他们通过比较招募就诊时的数据与招募前一次就诊的数据，将每只眼的青光眼分类为进展或非进展。使用 Kappa 统计确定盲法观察者和面对面评估之间的青光眼进展一致性。通过 Kappa 计算观察者内一致性，以比较由同一位提供者进行的面对面评估和远程评估（n=279 只眼）。
对 200 名受试者中的 399 只眼进行了分析。对于每个读者 1-4，在确定青光眼进展方面，面对面评估与远程评估之间的一致性分别为 63%、62%、69%和 68%（kappa 值分别为 0.19、0.20、0.35 和 0.33）。对于观察者内一致性，读者 1 对其自己的面对面评估的同意率为 65%（kappa=0.18）。
观察者内一致性与未亲自见患者的每位提供者的一致性相似。这种相似性表明，远程医疗在识别青光眼疾病进展方面可能同样有效，无论是否由同一提供者进行了门诊和远程评估。然而，公平的一致性水平突出了仅使用远程医疗数据来确定进展与在患者评估期间可用的临床详细信息相比的局限性。
