Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease - 07/05/21

Doi : 10.1016/j.jaad.2020.04.171

Colleen K. Gabel, BS ^a, Emily Nguyen, BS ^a, Ryan Karmouta, MD, MBA ^b, Kristina J. Liu, MD, MHS ^c, Guohai Zhou, PhD ^d, Allireza Alloo, MD ^e, Ryan Arakaki, MD ^f, Yevgeniy Balagula, MD ^g, Alina G. Bridges, DO ^h, Edward W. Cowen, MD, MHSc ⁱ, Mark Denis P. Davis, MD ^h, Alisa Femia, MD ^j, Joanna Harp, MD ^k, Benjamin Kaffenberger, MD ^l, Jesse J. Keller, MD ^m, Bernice Y. Kwong, MD ⁿ, Alina Markova, MD ^o, Melissa Mauskar, MD ^p, Robert Micheletti, MD ^q, Arash Mostaghimi, MD, MPH ^d, Joseph Pierson, MD ^r, Misha Rosenbach, MD ^q, Zachary Schwager, MD ^s, Lucia Seminario-Vidal, MD, PhD ^t, Victoria R. Sharon, MD, DTMH ^e, Philip I. Song, MD ^u, Lindsay C. Strowd, MD ^v, Andrew C. Walls, MD ^d, Karolyn A. Wanat, MD ^w, David A. Wetter, MD ^h, Scott Worswick, MD ^x, Carolyn Ziemer, MD, MPH ^y, Joseph Kvedar, MD ^a, Anar Mikailov, MD ^z, Daniela Kroshinsky, MD, MPH ^a,^⁎
^a Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
^b Division of Dermatology, University of California–Los Angeles, Los Angeles, California
^c Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
^d Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
^e Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
^f Department of Dermatology, University of California–San Francisco, San Francisco, California
^g Department of Medicine, Division of Dermatology, Montefiore Medical Center, Bronx, New York
^h Department of Dermatology, Mayo Clinic, Rochester, Minnesota
ⁱ Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
^j Department of Dermatology, New York University School of Medicine, New York, New York
^k Department of Dermatology, Weill Cornell Medicine, New York, New York
^l Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
^m Department of Dermatology, Oregon Health & Science University, Portland, Oregon
ⁿ Department of Dermatology, Stanford University School of Medicine, Stanford, California
^o Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
^p Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
^q Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
^r Dermatology Division, University of Vermont Medical Center, Burlington, Vermont
^s Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
^t Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
^u Department of Dermatology, Palo Alto Medical Foundation, Palo Alto, California
^v Department of Dermatology, Wake Forest Baptist Health, Winston-Salem, North Carolina
^w Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
^x Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, California
^y Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
^z Department of Dermatology, Beth Israel Lahey Health, Burlington, Massachusetts

^∗Correspondence to: Daniela Kroshinsky, MD, MPH, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, 2nd Floor, Boston, MA 02114.Department of DermatologyMassachusetts General Hospital50 Staniford St, 2nd FloorBostonMA02114

Abstract

Background

Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data.

Methods

This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic.

Results

There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone.

Limitations

Selection bias and single-center nature.

Conclusions

Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.

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Key words : dermatology consultations, dermatology hospitalists, inpatient dermatology, store-and-forward, teledermatology, telemedicine

Abbreviations used : CI, IQR

Plan

	Authors Gabel and Nguyen contributed equally to this article.
	Funding sources: None.
	Conflicts of interest: None disclosed.
	IRB approval status: Reviewed and approved by Partners IRB: 2018P002762.
	Reprints not available from the authors.

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Vol 84 - N° 6

P. 1547-1553 - juin 2021 Retour au numéro

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Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease - 07/05/21

Abstract

Background

Methods

Results

Limitations

Conclusions

Plan

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