Journal of the American Academy of Dermatology (JAAD)
Impact of teledermatology on the accessibility and efficiency of dermatology care in an urban safety-net hospital: A pre-post analysis
Published: August 12th, 2019
Adam Zakaria, BA; Toby Maurer, MD; George Su, MD; Erin Amerson, MD
Background
Teledermatology enables dermatologists to remotely triage and evaluate dermatology patients, but previous studies have questioned whether teledermatology is clinically efficient.
Objective
To determine whether implementation of a teledermatology system at the Zuckerberg San Francisco General Hospital and Trauma Center has improved the accessibility and efficiency of dermatology care delivery.
Methods
Retrospective, pre-post analysis of a pre-teledermatology cohort (June 2014-December 2014) compared with a post-teledermatology cohort (June 2017-December 2017).
Results
Our analysis captured 11,586 patients. After implementation of teledermatology, waiting times for new patients decreased significantly (84.6 days vs 6.7 days; P < .001), total cases evaluated per month increased significantly (754 vs 901; P = .008), and number of cases evaluated per dermatologist-hour increased significantly (2.27 vs 2.63; P = .010). In the post-teledermatology period, 61.8% of teledermatology consults were managed without a clinic visit.
Limitations
We were unable to control for changes in demand for dermatology evaluations between the 2 periods and did not have a control group with which to compare our results.
Conclusion
The dermatology service was more accessible and more efficient after implementation of teledermatology, suggesting that capitated health care settings can benefit from implementation of a teledermatology system.
Journal of the American Academy of Dermatology (JAAD)
Cost Minimization Analysis of a Teledermatology Triage System in a Managed Care Setting
Published: November 18th, 2020
Adam Zakaria, BA; Theodore A. Miclau, MS; Toby Maurer, MD; Kieron S. Leslie, MB, BS; Erin Amerson, MD
Importance
Teledermatology (TD) enables remote triage and management of dermatology patients. Previous analyses of TD systems have demonstrated improved access to care but an inconsistent fiscal impact.
Objective
To compare the organizationwide cost of managing newly referred dermatology patients within a TD triage system vs a conventional dermatology care model at the Zuckerberg San Francisco General Hospital and Trauma Center (hereafter referred to as the ZSFG) in California.
Design, Setting, and Paricipants
A retrospective cost minimization analysis was conducted of 2098 patients referred to the dermatology department at the ZSFG between June 1 and December 31, 2017.
Intervention
Implementation of the TD triage system in January 2015.
Main Outcomes and Measures
The main outcome was mean cost to the health care organization to manage newly referred dermatology patients with or without TD triage. To estimate costs, decision-tree models were constructed to characterize possible care paths with TD triage and within a conventional dermatology care model. Costs associated with primary care visits, dermatology visits, and TD visits were then applied to the decision-tree models to estimate the mean cost of managing patients following each care path for 6 months. The mean cost for each visit type incorporated personnel costs, with the mean cost per TD consultation also incorporating software implementation and maintenance costs. Finally, ZSFG patient data were applied within the models to evaluate branch probabilities, enabling calculation of mean cost per patient within each model.
Results
The analysis captured 2098 patients (1154 men [55.0%]; mean [SD] age, 53.4 [16.8] years), with 1099 (52.4%) having Medi-Cal insurance and 879 (41.9%) identifying as non-White. In the decision-tree model with TD triage, the mean (SD) cost per patient to the health care organization was $559.84 ($319.29). In the decision-tree model for conventional dermatology care, the mean (SD) cost per patient was $699.96 ($390.24). Therefore, the TD model demonstrated a statistically significant mean (SE) cost savings of $140.12 ($11.01) per patient. Given an annual dermatology referral volume of 3150 patients, the analysis estimates an annual savings of $441 378.
Conclusions and Relevance
Implementation of a TD triage system within the dermatology department at the ZSFG was associated with cost savings, suggesting that managed health care settings may experience significant cost savings from using TD to triage and manage patients.
Journal of the American Academy of Dermatology (JAAD)
Editorial
Economics of Teledermatology—Does the Math Add Up?
Published: November 18th, 2020
April W. Armstrong, MD, MPH; Indira Singh, MD
Teledermatology has the potential to improve timely access to care.1 This technology-enabled delivery of dermatology care has evolved over the past 2 decades, with increasing evidence demonstrating its accuracy and reliability.2 For the management of certain inflammatory skin conditions, clinical outcomes are equivalent between patients who were treated online and those treated in person.
Europe PubMed Central (PMC)
Utilizing Technology for Dermatology Care in Tajikistan: A Health Systems Perspective
Published: November 18th, 2020
Adam Zakaria, BA; Theodore A. Miclau, MS; Toby Maurer, MD; Kieron S. Leslie, MB, BS; Erin Amerson, MD
Key Points:
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In Tajikistan, where distances can be long and a large proportion of the population lives outside of major cities, teledermatology can serve as an effective method of skin care delivery.
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The authors designed a store-and-forward teledermatology program to allow dermatologists in smaller cities to consult with their most experienced colleagues in the capital city of Dushanbe on complex patient cases.
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Thus far, 228 consultations have taken place through the teledermatology platform, although several challenges to implementation exist.
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The application of a health systems framework by the World Health Organization, comprising various health systems building blocks, helped define the aims of the program and enabled putting in place needed elements to maximize program success.