Browsing by Subject "Telemedicine"
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Item Beyond the walls: moving acute care out of the traditional setting(2021-07-09) Harder, StephenItem Evaluating Teleretinal Imaging Detection of Diabetic Retinopathy in the Dallas County Hospital System(2018-01-23) Lee, Jessica; Nguyen, Lilian; Lee, Roxanne; Blomquist, PrestonINTRODUCTION: Diabetes mellitus (DM) is one of the most prevalent diseases in the United States. Approximately one third of patients with diabetes have diabetic retinopathy, which is the leading cause of new cases of blindness among US adults ages 20-76 years. The American Academy of Ophthalmology recommends annual screenings for diabetic retinopathy beginning 5 years after the onset of DM1 and beginning promptly after diagnosis of DM2. Only 60% of people with DM have yearly screenings, which consist of a dilated eye exam. Nonmydriatic digital retinal imaging with remote image interpretation (teleretinal screening) is a promising new technology because it allows rapid retinal imaging without dilation of the pupil in primary care clinics, with the potential to reach more patients, detect disease earlier, facilitate compliance, and reduce barriers to specialized eye care. PURPOSE: To evaluate the effectiveness of a diabetic retinopathy teleretinal screening program and follow-up in a high-risk population. METHODS: Diabetic patients who had teleretinal imaging performed between April 1, 2013 and March 10, 2017 at the community-based primary care clinics of the Parkland Memorial Hospital system were identified through Epic electronic health records. Patient age, sex, screening date and interpretation, completed follow-up eye clinic appointments, and ocular diagnoses were recorded. RESULTS: 1155 patient charts were reviewed and of those, 399 (34.5%) underwent the screening and had a teleretinal image obtained. Of those screened, 279 (69.9%) were referred to optometry or ophthalmology clinic, and 114 (40.8%) were later seen in clinic. The most common reasons for referral were a yellow report without a specific interpretation (83.5%), mild or moderate non-proliferative diabetic retinopathy (6.8%), nerve-related disease (4.7%), and red report without a specific interpretation (2.2%). The percentage of agreement for all diagnoses was 76.3% and total sensitivity was 72.7%. Diabetic retinopathy was detected for the first time through teleretinal screening in 44 patients (11.0%). CONCLUSIONS: Teleretinal screening is a useful method for detecting diabetic retinopathy. However improvements need to be made in follow up of ordered screenings, image quality and interpretation, and referral follow-up.Item Evaluating the Effectiveness of a Teledermatology on System Utilization in a Safety-Net Public Health and Hospital System(2020-05-01T05:00:00.000Z) Wu, Lawrence Wen; Dominguez, Arturo R.; Chong, Benjamin F.; Hynan, Linda S.BACKGROUND: Teledermatology is a potentially useful and cost-effective modality for triaging patients in a primary care setting. However, the effect of teledermatology on health system utilization in a safety net hospital system has not been studied. OBJECTIVE: To determine the effect teledermatology on dermatological-problem related healthcare system utilization. Our hypothesis was that teledermatology would be associated with decreased dermatological-problem related healthcare system utilization. METHODS: The design is a retrospective cohort study comparing patients referred by Parkland Community Outpatient Clinics (COPC) primary care providers for dermatology evaluation during Fiscal Year 2016 (October 1st, 2015 and September 30th, 2016): 1) Patients evaluated through SAF teledermatology, 2). Patients from COPCs that did not have teledermatology available to them and were referred for a face-to-face visit. 3.) Patients from the COPCs in cohort 1 that had teledermatology available but were referred for a face-to-face visit instead. Data from 6 months prior to originating encounter and 18 months post originating encounter were measured. Statistical analysis with binary categorical repeated measures for a saturated model analyzed for significant variations in utilization. Health system utilization was measured at primary care clinics, dermatology and other specialty care clinics, urgent care clinic, and Emergency Room visits at Parkland Memorial Hospital. We compared the demographic, diagnostic, and clinical management data of the 3 cohorts. We measured sex, age, race/ethnicity, health care coverage, and diagnostic category for all 3 cohorts. The patients were classified as either having an inflammatory or neoplastic skin condition. The primary outcome was the percentage of patients with at least 1 visit in a 6-month time interval. Secondary outcomes measured were referral treatment capture rate, time to definitive treatment, and teledermatology response time. RESULTS: There were 809 total participants comprising the 3 cohorts, which were 64% female and with a mean age of 50.4 years. Baseline characteristics among groups were similar except for a higher proportion of eczematous conditions in the teledermatology cohort. Over the 24 month study period, total health system utilization, defined as the percentage of patients with at least 1 visit in each 6-month time interval measured over 4 intervals, was significantly greater for patients with inflammatory conditions receiving a face-to-face referral from both teledermatology and non-teledermatology-utilizing clinics compared to patients receiving teledermatology consults. There are no significant differences all combined, dermatology, and PCP clinic utilization between the face-to-face referrals from teledermatology and non-teledermatology-utilizing groups. CONCLUSION: This study provides evidence for the potential effectiveness of teledermatology improving access to care and reducing system utilization for patients with an inflammatory skin condition in a large safety-net public hospital system. There was no significant difference in utilization in patients with a neoplastic condition. Our results suggest additional benefits of utilizing a teledermatology system in a safety net hospital system.Item Internal medicine telehealth for the future(2020-05-15) Ali, Sadia; Almandoz, Jaime; Thibodeau, Jennifer; Vemulapalli, RoopaItem Looking Back on Creating a COVID Telemedicine(2022-05-01T05:00:00.000Z) Murtuza, Mohammad Imran; Reed, W. Gary; Croft, Carol; Phelps, EleanorBACKGROUND: In March 2020, the Dallas Fort Worth (DFW) Metroplex experienced a surge in acute COVID-19 infections. At that time, no consistent protocols existed for follow-up of discharged patients with COVID-19 from the William P. Clements Jr. University Hospital at the University of Texas Southwestern Medical Center (UTSW). Simultaneously, medical students were suspended from in-person clinical activities to limit viral spread. In response to these events, a telemedicine elective was created to provide timely and high-quality telehealth follow-up for recently discharged COVID-19 patients from April of 2020 to July of 2020. METHODS: The pilot team, consisting of several second- through fourth-year medical students, developed a call script that included warning signs and symptoms, CDC guidelines for isolation, and primary care physician referral information. COVID-19 patients discharged from the Emergency Department and inpatient services were identified and assigned to student callers. All patients were discussed with an attending physician, who was available if an acute issue arose. The elective also included education on the SBAR handover technique, telehealth education, updated COVID-19 literature, and CDC guidelines. RESULTS: Improvement was noted in students' ability to identify patients who required escalation of care, as seen by over 60% of patients who were advised to return to ED required hospital admission. Statistically significant improvement was observed in the students' degree of feeling informed about the current state of COVID-19 and their degree of comfort with interviewing patients over the phone. DISCUSSION: This elective provided quality virtual healthcare to COVID-19 patients while allowing medical students to progress in their medical education and participate in patient care. This elective was an example of an early adopter of telemedicine in COVID-19 follow up. Now two years into the COVID-19 pandemic, the CDC, NIH, and health systems all around the United States have made virtual visits commonplace when treating patients with COVID-19 and beyond.Item Optimizating and Diffusing a Handover Behavioral Assessment Tool for Simulation(2021-03-18) Chen, Rodney; Reed, W. Gary; Greilich, Philip; Phelps, EleanorINTRODUCTION: With multiple simulated and clinical scenarios included in the ongoing Quality Enhancement Plan (QEP), a standardized approach to assessing and trending handover quality across class years could quantify the improvements established through the QEP. This study assesses the utility of the Liang Handover Assessment Tool for Simulation (L-HATS), a valid and reliable behavioral assessment tool tested during the transition to clerkship (T2C) handover module. Here, we use the L-HATS to assess handovers delivered during residency essentials (RE) and COVID-19 telehealth courses, checking for tool reliability in settings other than T2C. In cases where we find the tool to be less reliable, we optimize the L-HATS by improving the observer training course. The study aim is to confirm tool reliability of ICC>0.75, consistent with levels of reliability found during testing in the T2C module. METHODS: We select volunteer observers from a group of medical students who had completed the T2C course, with each observer assigned a set of videos to score for each activity. The primary outcome measure for this study is the two-way random effects ICC, which represents tool inter-rater reliability in each novel activity. An ICC>0.75 is considered good reliability, an ICC 0.5-0.75 is considered moderate reliability, and an ICC<0.5 is considered poor reliability. As the volunteer observer training improves across activities, we assess for observers' intra-rater reliability. Intra-rater reliability is assessed along the same scale used for inter-rater reliability. RESULTS: RE inter-rater reliability was 0.561 [0.167, 0.953], with each of six observers scoring four videos. COVID-19 telehealth inter-rater reliability was 0.644 [0.244, 0.964], with five observers each scoring four videos. The intra-rater reliability calculated for the telehealth course ranged from 0.105 [-0.361, 0.863] to 0.667 [0.020, 0.971]. CONCLUSION: This study demonstrates moderate levels of reliability in both the RE and telehealth courses. However, neither novel activity could match the reliability scores calculated during original L-HATS testing, suggesting that the tool is less reliable in settings outside of the T2C course. Future studies might increase the number of graded videos per handover activity, to narrow the confidence intervals found in the present study. Moreover, we find that a universally flexible assessment tool is difficult to design, suggesting that each new learning activity may require a uniquely tailored behavioral assessment tool.Item [Southwestern News](2005-02-10) Morales, Katherine