Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer.
comparative effectiveness research
dermatology/diagnosis
dermatology/epidemiology
dermatology/organization and administration
skin cancer
telemedicine
Journal
Journal of the American Academy of Dermatology
ISSN: 1097-6787
Titre abrégé: J Am Acad Dermatol
Pays: United States
ID NLM: 7907132
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
03
07
2018
revised:
11
01
2019
accepted:
19
01
2019
pubmed:
11
2
2019
medline:
31
3
2020
entrez:
11
2
2019
Statut:
ppublish
Résumé
The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood. We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows. Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017. 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. Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias. Implementation is critical to the effectiveness of teledermatology.
Sections du résumé
BACKGROUND
BACKGROUND
The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood.
OBJECTIVE
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
METHODS
Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017.
RESULTS
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
CONCLUSIONS
Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias.
CONCLUSION
CONCLUSIONS
Implementation is critical to the effectiveness of teledermatology.
Identifiants
pubmed: 30738843
pii: S0190-9622(19)30178-1
doi: 10.1016/j.jaad.2019.01.067
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1099-1106Informations de copyright
Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.