Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer - 11/10/19
Abstract |
Background |
The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood.
Objective |
We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows.
Methods |
Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017.
Results |
One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective.
Limitations |
Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias.
Conclusion |
Implementation is critical to the effectiveness of teledermatology.
Il testo completo di questo articolo è disponibile in PDF.Key words : comparative effectiveness research, dermatology/diagnosis, dermatology/epidemiology, dermatology/organization and administration, skin cancer, telemedicine
Abbreviations used : CI, EMR, RR
Mappa
| Funding sources: Supported solely by The Permanente Medical Group, Rapid Analytics Unit. |
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| Conflicts of interest: None disclosed. |
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| Reprints are not available from the authors. |
Vol 81 - N° 5
P. 1099-1106 - novembre 2019 Ritorno al numero
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