Lindsay Daniel, Bates Nicole, Callander Emily, Johnston Karen, Carlisle Karen, Smith Deb, Evans Rebecca, Larkins Sarah
College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia.
Menzies School of Health Research, Charles Darwin University, Australia.
J Telemed Telecare. 2023 Apr;29(3):203-210. doi: 10.1177/1357633X20975653. Epub 2020 Dec 6.
Breast cancer is the most commonly diagnosed cancer in Australian women. Given the diverse geography and populations within Australia, the ability to offer a telemedicine-supported breast screening and assessment service may increase access. The aim of this study was to assess clinical outcomes of a telemedicine-based remote radiology assessment service delivery model for detecting breast cancer in regional Australian women compared to the traditional radiologist onsite model.
This study was a pre-post intervention study using de-identified administrative data. Data were collected from seven sites across three health jurisdictions within Australia. There were a total of 21,117 assessment visits, with 10,508 (49.8%) pre- and 10,609 (50.2%) post-remote model implementation. Of the 10,609 post-remote model visits, 3,904 (36.8%) were under the remote model. The main outcome was cancer detection, split into any cancer, any invasive cancer or any small invasive cancer. Timeliness of assessment was also examined.
After adjusting for multiple factors, there were no statistically significant differences in cancer detection rates between the remote and onsite models (adjusted odds ratio (AOR) = 1.02, 95% CI 0.86-1.19, n.s.). Implementing the remote assessment model had statistically significant positive effects on the timeliness of assessment (AOR = 0.68, 95% CI 0.59-0.77, p < 0.001).
This study found the remote model delivers safe and high-quality assessment services, with equivalent rates of cancer detection and improved timeliness of assessment when compared to the traditional onsite model. Careful monitoring and ongoing evaluation of any health-service model is important for ongoing safety, efficiency and acceptability.
乳腺癌是澳大利亚女性中最常被诊断出的癌症。鉴于澳大利亚地域和人口的多样性，提供远程医疗支持的乳房筛查和评估服务或许能增加可及性。本研究的目的是评估一种基于远程医疗的远程放射学评估服务提供模式在检测澳大利亚偏远地区女性乳腺癌方面的临床结果，并与传统的放射科医生现场模式进行比较。
本研究是一项使用去识别行政数据的干预前后研究。数据从澳大利亚三个卫生辖区的七个地点收集。总共有21,117次评估就诊，其中10,508次（49.8%）在远程模式实施前，10,609次（50.2%）在远程模式实施后。在10,609次远程模式实施后的就诊中，3,904次（36.8%）采用远程模式。主要结果是癌症检测，分为任何癌症、任何浸润性癌症或任何小浸润性癌症。还检查了评估的及时性。
在对多个因素进行调整后，远程模式和现场模式之间的癌症检测率没有统计学上的显著差异（调整后的优势比（AOR）=1.02，95%置信区间0.86 - 1.19，无统计学意义）。实施远程评估模式对评估的及时性有统计学上的显著积极影响（AOR = 0.68，95%置信区间0.59 - 0.77，p < 0.001）。
本研究发现，与传统的现场模式相比，远程模式提供了安全且高质量的评估服务，癌症检测率相当，评估及时性有所提高。对任何医疗服务模式进行仔细监测和持续评估对于持续的安全性、效率和可接受性很重要。
