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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le lundi 17 février 2020
Doi : 10.1016/j.jaad.2020.01.030
accepted : 11 January 2020
Inpatient teledermatology: Diagnostic and therapeutic concordance among a hospitalist, dermatologist, and teledermatologist using store-and-forward teledermatology
 

Jesse J. Keller, MD a, , Jacob P. Johnson, MA a, Emile Latour, MS b
a Department of Dermatology, Oregon Health & Science University, Portland, Oregon 
b Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon 

Reprint requests: Jesse J. Keller, MD, 3303 SW Bond Ave CH16D, Portland, OR 97239.3303 SW Bond Ave CH16DPortlandOR97239
Abstract
Background

Inpatient dermatology has been shown to improve patient outcomes at a reduced cost. Few hospitals have dermatologists available. Teledermatology may allow dermatologists to assess hospitalized patients remotely.

Objective

To examine the diagnostic concordance between a hospitalist, dermatologist, and teledermatologist using store-and-forward teledermatology.

Methods

For 100 consecutive patients requiring inpatient dermatology consultation, a survey was conducted by all 3 raters to convey diagnostic impressions and therapeutic recommendations. Complete and partial agreements were assessed using the Cohen kappa statistic.

Results

Inpatient dermatology consultation often resulted in a change in diagnosis (50.9%) and a change in systemic therapy (41.5%). Likewise, virtual teledermatology consultation would have resulted in a change in diagnosis (54.7%) and a change in systemic therapy (47.2%) at similar rates. Comparing the dermatologist and teledermatologists, diagnostic complete and partial agreement were 52.8% and 84.9%, respectively. Systemic therapy agreement was 77.4%. Teledermatologists recommended biopsy more often (68.5% vs 43.5%).

Limitations

Small sample size, tertiary academic medical center, single rater for inpatient teledermatology with specific inpatient niche.

Conclusion

Teledermatologists performed comparably to an in-person dermatologist for the diagnosis and management of hospitalized patients with skin conditions. Teledermatology may be a suitable alternative for delivery of inpatient care if no dermatologist is available.

The full text of this article is available in PDF format.

Key words : agreement, concordance, dermatology, inpatient, teledermatology, telehealth, telemedicine



 Funding sources: None.
 Conflicts of interest: None disclosed.
 IRB approval status: Reviewed and approved by the Oregon Health & Science University IRB (17365).



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