Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Gastroenterol Hepatol. 2023 Jun;38(6):999-1007. doi: 10.1111/jgh.16194. Epub 2023 Apr 28.
Telemedicine is an evolving tool to provide health-care services. We evaluated the suitability of telemedicine to deliver effective consultation for hepatobiliary disorders.
In this prospective study spanning over a year, we interviewed hepatologists delivering the teleconsultations through a pre-validated questionnaire. A consult was deemed suitable based on the physician's judgment in the absence of unplanned hospitalization. We evaluated factors determining the suitability through inferential statistics and machine learning models, namely, extreme gradient boosting (XGB) and decision tree (DT).
Of 1118 consultations, 917 (82.0%) were deemed suitable. On univariable analysis, patients with skilled occupation, higher education, out-of-pocket expenses, and diseases such as chronic hepatitis B, C, and non-alcoholic fatty liver disease (NAFLD) without cirrhosis were associated with suitability (P < 0.05). Patients with cirrhosis (compensated or decompensated), acute-on-chronic liver failure (ACLF), and biliary obstruction were likely unsuitable (P < 0.05). XGB and DT models predicted suitability with an area under the receiver operating curve of 0.808 and 0.780, respectively. DT demonstrated that compensated cirrhosis with higher education or skilled occupation with age < 55 years had 78% chance of suitability whereas hepatocellular carcinoma, decompensated cirrhosis, and ACLF patients were unsuitable with a 60-95% probability. In non-cirrhotic liver diseases, hepatitis B, C, and NAFLD were suitable, with a probability of 89.7%. Biliary obstruction and previous failure of teleconsultation were unsuitable, with a probability of 70%. Non-cirrhotic portal fibrosis, dyspepsia, and dysphagia not requiring intervention were suitable (probability: 88%).
A simple decision tree can guide the referral of unsuitable and the management of suitable patients with hepatobiliary diseases through telemedicine.
远程医疗是提供医疗服务的一种不断发展的工具。我们评估了远程医疗为肝胆疾病提供有效咨询的适宜性。
在这项为期一年多的前瞻性研究中，我们通过预先验证的问卷采访了提供远程咨询的肝病专家。如果没有计划外住院治疗，医生判断咨询合适，则认为咨询合适。我们通过推断统计学和机器学习模型（即极端梯度增强 (XGB) 和决策树 (DT)）评估确定适宜性的因素。
在 1118 次咨询中，917 次（82.0%）被认为是合适的。单变量分析显示，具有熟练职业、高学历、自费和乙型肝炎、丙型肝炎和非酒精性脂肪性肝病 (NAFLD) 等疾病但无肝硬化的患者与适宜性相关（P < 0.05）。肝硬化（代偿或失代偿）、慢加急性肝衰竭 (ACLF) 和胆道梗阻的患者可能不合适（P < 0.05）。XGB 和 DT 模型预测适宜性的受试者工作特征曲线下面积分别为 0.808 和 0.780。DT 表明，年龄 < 55 岁且具有高等教育或熟练职业的代偿性肝硬化患者，其适宜性的可能性为 78%，而肝细胞癌、失代偿性肝硬化和 ACLF 患者则不适宜，可能性为 60-95%。在非肝硬化性肝病中，乙型肝炎、丙型肝炎和 NAFLD 是适宜的，可能性为 89.7%。胆道梗阻和先前远程咨询失败是不合适的，可能性为 70%。非肝硬化性门静脉纤维化、消化不良和不需要干预的吞咽困难是合适的（可能性：88%）。
一个简单的决策树可以指导肝胆疾病患者通过远程医疗转诊不适合的患者，并管理适合的患者。
