Department of Dermatology, Hôpital Henri Mondor, APHP, Créteil, France; Chaire Avenir Santé numérique, Equipe 8 IMRB U 955, INSERM, Université Paris Est Créteil, Créteil France, France.
Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France.
Int J Med Inform. 2021 Feb;146:104361. doi: 10.1016/j.ijmedinf.2020.104361. Epub 2020 Dec 8.
Teledermatology was raised as a potential answer to increase access and decrease delay for skin cancer management. However, its influence on non-melanoma skin cancer (NMSC) care pathway has never been studied.
To compare conventional care pathway to teledermatology (TD) in NMSC care pathways using a process modelling approach.
A period study including three groups was conducted in a department of dermatology. During the first period from January till February 2013 a NMSC care pathway was mapped for a group a prior TD integration. During the second period from September 2016 till October 2018, the NMSC care pathway was determined for patients managed by a conventional care process and after TD diagnosis. Patients characteristics, type of tumors and processes were compared using time as a key performance indicator. Mean were reported with their ± SD. Linear regression was performed using time between multidisciplinary consultation and surgery as outcome adjusted on sex, age and cancer type.
During the first period (prior to TD) 89 NMSC patients were managed (mean age = 76 yr old ± 13) during the second period, 36 patients NMSC were managed after TD, mean age of 89 years old ± 6 and 954 patients in a conventional process, mean age of 78 years old ±12. In comparison between the two periods patient's age, sex and cancer distribution significantly differed while the rate of surgery was not significantly different (p = 0.967). Linear multivariate regression using time between multidisciplinary consultation and surgery as outcome adjusted on sex age and cancer type displayed that during the second period patients in the TD group spent 17.6 days more [0.98,34.25] while patient in the conventional care process group had 9.8 days [1.85,17.74] more than patient in the study period 1, (p = 0.04, p = 0.02) without significant difference for age and sex (p = 0.29, p = 0.51). Patients with a SCC had a decreased time between multidisciplinary consultation and surgery of -12.97 days [-17.43, -8.5], p < 10.
Interestingly, patients managed by TD were significantly older than those managed using a conventional care pathway. Unexpectedly their total time spent in the process was not shorter. The results of this analysis illustrated the interest of using process modelling approach to assess the impact of a healthcare innovation integration and to further rethink coordination and care pathways for NSMC post TD.
远程皮肤病学被提出来作为增加皮肤癌管理的可及性和减少延迟的一种潜在方法。然而，它对非黑素瘤皮肤癌（NMSC）护理途径的影响从未被研究过。
使用流程建模方法比较 NMSC 护理途径中的常规护理途径与远程皮肤病学（TD）。
在皮肤科进行了一项包括三个组的时期研究。在第一个时期，从 2013 年 1 月到 2 月，为一组患者绘制了 NMSC 护理途径图，该组患者在 TD 整合之前接受了护理。在第二个时期，从 2016 年 9 月到 2018 年 10 月，确定了通过常规护理流程和 TD 诊断后管理的患者的 NMSC 护理途径。使用时间作为关键绩效指标比较患者特征、肿瘤类型和流程。报告平均值及其 ±SD。使用多学科咨询和手术之间的时间作为结果进行线性回归，调整性别、年龄和癌症类型。
在第一个时期（TD 之前），管理了 89 例 NMSC 患者（平均年龄 76 岁±13 岁）；在第二个时期，管理了 36 例 NMSC 患者，平均年龄为 89 岁±6 岁；954 例患者接受了常规治疗，平均年龄为 78 岁±12 岁。与两个时期相比，患者年龄、性别和癌症分布差异显著，而手术率无显著差异（p = 0.967）。使用多学科咨询和手术之间的时间作为结果进行线性多变量回归，调整性别、年龄和癌症类型，显示在第二个时期，TD 组的患者多花费了 17.6 天[0.98，34.25]，而常规护理组的患者多花费了 9.8 天[1.85，17.74]。与研究期 1 相比，（p = 0.04，p = 0.02），年龄和性别无显著差异（p = 0.29，p = 0.51）。患有 SCC 的患者的多学科咨询和手术之间的时间减少了-12.97 天[-17.43，-8.5]，p < 10。
有趣的是，接受 TD 治疗的患者明显比接受常规护理途径治疗的患者年龄大。出乎意料的是，他们在整个过程中花费的时间并没有更短。该分析结果说明了使用流程建模方法评估医疗保健创新整合的影响并进一步重新思考 NSMC 后 TD 的协调和护理途径的重要性。
