Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer
| Autor: | Eileen Crowley, Lisa J. Herrinton, Danny Wukda, Sangeeta Marwaha, Helene B. Fevrier, Michael Hartmann, Michael Haiman, Melanie J. Tuerk, Stacey E. Alexeeff, Ngoc Pham |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Telemedicine Teledermatology Skin Neoplasms Adolescent Referral Biopsy Comparative effectiveness research Dermatology Workflow Young Adult 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Picture archiving and communication system Humans Medicine Medical physics Aged Retrospective Studies business.industry Reproducibility of Results Retrospective cohort study Middle Aged Confidence interval 030220 oncology & carcinogenesis Relative risk Female business |
| Zdroj: | Journal of the American Academy of Dermatology. 81:1099-1106 |
| ISSN: | 0190-9622 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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