Dermatology, Kaiser Permanente, Sacramento, California.
Division of Research, Kaiser Permanente, Oakland, California.
J Am Acad Dermatol. 2019 Nov;81(5):1099-1106. doi: 10.1016/j.jaad.2019.01.067. Epub 2019 Feb 7.
The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood.
We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows.
Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017.
One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective.
Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias.
Implementation is critical to the effectiveness of teledermatology.
远程皮肤病学和面对面工作流程在诊断病变方面的效果和价值尚未得到充分了解。
我们比较了 2 种面对面工作流程（直接转诊和流动皮肤科医生）和 4 种远程皮肤病学工作流程在活检和癌症诊断方面的风险。
回顾性研究了 2017 年 1 月至 6 月期间因病变就诊的 59279 名初级保健患者。
一种远程皮肤病学工作流程使用配备有皮肤镜的数码相机、图片存档和通信系统以及从大型计算机显示器检索图像（与智能手机屏幕相比）来实现高分辨率图像。与直接转诊相比，这种工作流程与癌症检出率增加 9%（95%置信区间 [CI]，2%-16%）、活检率降低 4%（相对风险，0.96；95% CI，0.93-0.99）和面对面就诊次数减少 39%（相对风险，0.61；95% CI，0.57-0.65）相关。其他工作流程效果较差。
远程皮肤病学工作流程的熟练程度不同以及直接转诊患者的选择可能导致了偏差。
实施对于远程皮肤病学的有效性至关重要。
