Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease
| Autor: | Carolyn Ziemer, Misha Rosenbach, Scott Worswick, Joseph C. Pierson, Lindsay C. Strowd, Daniela Kroshinsky, Joseph C. Kvedar, Victoria R. Sharon, Karolyn A. Wanat, Anar Mikailov, Andrew C. Walls, Philip Song, Allireza Alloo, Alina G. Bridges, Melissa M. Mauskar, David A. Wetter, Mark D.P. Davis, Jesse J. Keller, Alisa N. Femia, Bernice Y. Kwong, Emily D. Nguyen, Yevgeniy Balagula, Joanna Harp, Benjamin H. Kaffenberger, Robert G. Micheletti, Edward W. Cowen, Kristina J. Liu, Ryan Karmouta, Zachary Schwager, Arash Mostaghimi, Alina Markova, Ryan Arakaki, Lucia Seminario-Vidal, Colleen K. Gabel, Guohai Zhou |
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| Rok vydání: | 2021 |
| Předmět: |
Selection bias
Telemedicine medicine.medical_specialty Teledermatology business.industry media_common.quotation_subject Dermatology Disease 030207 dermatology & venereal diseases 03 medical and health sciences Inter-rater reliability 0302 clinical medicine Interquartile range 030220 oncology & carcinogenesis Medicine Differential diagnosis business Prospective cohort study media_common |
| Zdroj: | Journal of the American Academy of Dermatology. 84:1547-1553 |
| ISSN: | 0190-9622 |
| DOI: | 10.1016/j.jaad.2020.04.171 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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