Improved patient access and outcomes with the integration of an eConsult program (teledermatology) within a large academic medical center - 03/03/20

Doi : 10.1016/j.jaad.2019.10.053

Rebecca F. Wang, MD ^a, John Trinidad, MD, MPH ^a, Jeffrey Lawrence, MD, MBOE ^b, Llana Pootrakul, MD, PhD ^a, L. Arick Forrest, MD ^c, Kevin Goist, MD ^b, Edward Levine, MD ^d, Shalina Nair, MD, MBA ^e, Milisa Rizer, MD, MPH ^e, Andrew Thomas, MD, MBA ^b, Randell Wexler, MD, MPH ^e, Benjamin H. Kaffenberger, MD ^a,^⁎
^a Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
^b Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
^c Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
^d Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
^e Department of Family Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio

^∗Correspondence to: Benjamin H. Kaffenberger, MD, OSU Dermatology, 2012 Kenny Rd, 2nd Floor, Columbus, OH 43212.OSU Dermatology2012 Kenny Rd2nd FloorColumbusOH43212

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Abstract

Background

Insurance, racial, and socioeconomic health disparities continue to pose significant challenges for access to dermatologic care. Studies applying teledermatology to increase access to underinsured individuals and ethnic minorities are limited.

Objective

To determine how the implementation of a teledermatology program affects access to health care and patient outcomes.

Methods

A cross-sectional evaluation was performed of all ambulatory dermatology referrals and electronic dermatology consultations (eConsults) at Ohio State University within a 25-month period.

Results

Compared with ambulatory referrals, eConsults served more nonwhite patients (612 of 1698 [36.0%] vs 4040 of 16,073 [25.1%]; P < .001) and more Medicaid enrollees (459 of 1698 patients [27.0%] vs 3266 of 16,073 [20.3%]; P < .001). In addition, ambulatory referral patients were significantly less likely to attend their scheduled appointment compared with eConsult patients, as either “no-shows” (246 of 2526 [9.7%] vs 3 of 62 [4.8%]) or cancellations (742 of 2526 [29.4%] vs 8 of 62 [12.9%]; P = .003). There were fewer median days to extirpation for eConsult patients compared with ambulatory referral patients (interquartile range; 80.7 ± 79.8 vs 116.9 ± 86.6 days; P = .004).

Conclusion

Integrating dermatologic care through a telemedicine system can result in improved access for underserved patients through improved efficiency outcomes.

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Key words : e-Consult, electronic consultation, health disparities, socioeconomic disparities, teledermatology, telemedicine

Plan

Methods

Study design and sample population

eConsult diagnosis categories

Referral volume and provider use

Appointment waiting time and completion status

Diagnosis and management of suspicious lesions

Discussion

Conclusion

	Funding sources: This study was funded by the Upper Payment Limit Awards granted through the Ohio Department of Medicaid to Drs Wexler and Kaffenberger.
	Conflicts of interest: None disclosed.
	IRB approval status: This study used quality control data and was exempt from Institutional Review Board review.
	Reprints not available from the authors.