Promoting High Value Care Through Teledermatology

From the 2019 HVPAA National Conference

Mr. Lawrence Wu (UT Southwestern Medical Center), Mr. Bahir Chamseddin (UT Southwestern Medical Center), Ms. Sung Kyung Cho (UT Southwestern Medical Center), Dr. Benjamin Chong (UT Southwestern Medical Center), Dr. Arturo Dominguez (UT Southwestern Medical Center)

Background

Store-and-forward (SAF) Teledermatology is a potentially useful and cost-effective modality for triaging patients in a primary care setting. A 2016 pilot study at Parkland Health and Hospital System (PHHS) described an EPIC™ based SAF teledermatology system that was effective in reducing median time to evaluation, median time to treatment, and efficacy in management of patients by PCPs. For fiscal year 2018, approximately 900 consults were completed. Although, teledermatology has been found to be cost-effective on a case-by-case basis in several studies, particularly through by reducing the need for face-to-face visits and reducing travel costs for patients, studies have not assessed its effect on total utilization within a health care system over a period of time.

Objective

The purpose of this study was to evaluate the effect of teledermatology on total healthcare systems utilization.

Methods

We performed a retrospective chart review of 809 randomized patients who received a teledermatology consult (285), face-to-face dermatology referral from a clinic with access to teledermatology (239) or face-to-face dermatology referral from a clinic without access to teledermatology (285). We then sought to identify encounters in the 6 months prior and 18 months post-teledermatology consult or face-to-face referral to identify clinic visits (primary care provider, dermatology, subspecialty), emergency department visits and hospitalizations related to the primary reason for dermatology consult or referral. For the clinical encounter to be counted, the dermatological problem did not have be the primary reason for visit, but had to be mentioned in the history of present illness, review of systems or assessment and plan of the provider’s note.

We further divided each group by their diagnostic category, specifically neoplasm versus inflammatory conditions due to fundamental differences in management. Neoplasms were considered to be benign tumors/proliferations, premalignant/malignant lesions, and neoplasm of unknown significance. Inflammatory conditions were considered to be eczematous, infectious, papulosquamous, acneiform/follicular occlusion, alopecia, pigmentation change or vitiligo.

Results

The mean number of visits per patient with inflammatory conditions over 24 months for teledermatology referral, face-to-face referral in non-teledermatology clinics, and face-to-face referral in teledermatology clinics were 1.50, 2.60, and 3.29 respectively. The mean number of visits per patients with neoplasms over 24 months for teledermatology referral, face-to-face referral in non-teledermatology clinics, and face-to-face referral in teledermatology clinics were 2.12, 2.14, and 1.83 respectively. We found a statistically significant decrease (p<0.001) in clinic visits for patients with inflammatory conditions at clinics with access to teledermatology, with 1.1 less visits for these patients at clinics with access to teledermatology compared to clinics without access to teledermatology. These decrease in visits were driven by mostly through decreased dermatology clinic visits with a mean number of visits per patient with inflammatory conditions over 24 months for teledermatology referral, face-to-face referral in non-teledermatology clinics, and face-to-face referral in teledermatology clinics were 0.52, 1.53, and 1.96 respectively. There was no statistically significant difference in utilization for patients with neoplasms, or in utilization for subspecialty clinics and hospitalizations.

Conclusions

Our data suggests that teledermatology is associated with decreased systems utilization in patients with inflammatory conditions and further studies are needed to validate this finding.

Clinical Implications

Teledermatology improved the quality of patient care at and experience at PHHS by reducing time to see a provider and may be an effective method of triaging patients with rash conditions given an associated decrease in overall hospital system utilization.

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