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Front Public Health. 2014 Oct 28;2:211. doi: 10.3389/fpubh.2014.00211. eCollection 2014.

Assessing the Quality of Teleconsultations in a Store-And-Forward Telemedicine Network - Long-Term Monitoring Taking into Account Differences between Cases.

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Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway , Tromsø , Norway ; Faculty of Health Sciences, University of Tromsø , Tromsø , Norway.
Médecins Sans Frontières International , Geneva , Switzerland.
Department of Medical Ethics and Legal Medicine, EA 4569, Paris Descartes University , Paris , France ; Fondation Médecins Sans Frontières , Paris , France.


We have previously proposed a method for assessing the quality of individual teleconsultation cases; this paper proposes an additional step to allow the long-term monitoring of quality. The basic scenario is a teleconsultation system (aka an e-referral system or a tele-expertise system) where the referrer posts a question about a clinical case, the question is relayed to an appropriate expert, and the chosen expert provides an answer. The people running this system want assurances that it is stable, i.e., they want routine quality assurance information about the "output" from the "process." This requires two things. It needs a method of assessing the quality of individual patient consultations. And it needs a method for taking into account differences between patients, so that these quality assessments can be compared longitudinally. Building on the previously proposed methodology, the present paper proposes two techniques for measuring the difficulty posed by a particular teleconsultation. The first is an indirect method, similar to a willingness to pay economic estimation. The second is a direct method. Using these two methods with real data from a telemedicine network showed that the first method was feasible, but did not produce useful results in a pilot trial. The second method, while more laborious, was also feasible and did produce useful results. Thus, when output quality is measured, an allowance can be made for the characteristics of the case submitted. This means that fluctuations in output quality can be attributed to variations in the process (network) or to variations in the raw materials (queries submitted to the network). Long-term quality assurance should assist those providing telemedicine services in low-resource settings to ensure that the services are operated effectively and efficiently, despite the constraints and complexities of the environment.


LMICs; quality assurance; quality control; telehealth; telemedicine

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