Evaluating the Effectiveness of a Teledermatology on System Utilization in a Safety-Net Public Health and Hospital System

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.