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J Am Acad Dermatol. 2019 Aug 12. pii: S0190-9622(19)32563-0. doi: 10.1016/j.jaad.2019.08.016. [Epub ahead of print]

Impact of Teledermatology on the Accessibility and Efficiency of Dermatology Care in an Urban Safety-Net Hospital: A Pre-Post analysis.

Author information

1
University of California, San Francisco (UCSF) School of Medicine.
2
Department of Dermatology, UCSF 1701 Divisadero St, San Francisco CA 94115; Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco CA 94110.
3
Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco CA 94110; Department of Medicine, Division of Pulmonary and Critical Care, UCSF 1001 Potrero Ave, Room 5K1, San Francisco, CA 94110.
4
Department of Dermatology, UCSF 1701 Divisadero St, San Francisco CA 94115; Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco CA 94110. Electronic address: Erin.Amerson@ucsf.edu.

Abstract

BACKGROUND:

Teledermatology enables dermatologists to remotely triage and evaluate dermatology patients, but previous studies have questioned whether teledermatology is clinically efficient.

OBJECTIVE:

Determine whether implementation of a teledermatology system at the Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) has improved the accessibility and efficiency of dermatology care delivery.

METHODS:

Retrospective, pre-post analysis comparing a pre-teledermatology cohort (June 2014 - December 2014) to a post-teledermatology cohort (June 2017 - December 2017) RESULTS: Our analysis captured 11,586 patients. After implementation of teledermatology, wait times for new patients decreased significantly (84.6 days vs. 6.7 days; p < 0.001), total cases evaluated per month increased significantly (754 vs. 901; p = 0.008), and number of cases evaluated per dermatologist-hour increased significantly (2.27 vs. 2.63; p = 0.010). 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 two periods and did not have a control group with which to compare our results.

CONCLUSIONS:

and Relevance: The dermatology service was both more accessible and more efficient following implementation of teledermatology, suggesting that capitated health care settings can benefit from implementation of a teledermatology system.

KEYWORDS:

access; appointments avoided; efficiency; store-and-forward; teledermatology; telehealth; telemedicine; underserved populations

PMID:
31415834
DOI:
10.1016/j.jaad.2019.08.016

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