Teledermatology to Facilitate Patient Care Transitions From Inpatient to Outpatient Dermatology: Mixed Methods Evaluation

Abstract

Background Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination–dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap. Objective Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care. Methods Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients. Results More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic’s capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19–related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient’s own. Conclusions Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers’ preferences.

Advancing Dermatological Care: A Comprehensive Narrative Review of Tele-Dermatology and mHealth for Bridging Gaps and Expanding Opportunities beyond the COVID-19 Pandemic

“…Nine reviews [22][23][24][25][28][29][30]36,38] and one systematic review [32]; • Twenty-five papers [21,26,27,31,[33][34][35][40][41][42][43][44][45]48,[50][51][52][53][54][55][56][57][58][59][60].…”

“…The search provided 40 components [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] in the three years since the COVID-19 pandemic outbreak (at the date of this study).…”

“…In detail, the components were: Two randomized controlled (clinical) trials (RCTs) [ 37 , 49 ]; Three observational studies (OS)s [ 39 , 46 , 47 ]; Nine reviews [ 22 , 23 , 24 , 25 , 28 , 29 , 30 , 36 , 38 ] and one systematic review [ 32 ]; Twenty-five papers [ 21 , 26 , 27 , 31 , 33 , 34 , 35 , 40 , 41 , 42 , 43 , 44 , 45 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. …”

“…Twenty-five papers [ 21 , 26 , 27 , 31 , 33 , 34 , 35 , 40 , 41 , 42 , 43 , 44 , 45 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ].…”

Evaluating clinician‐led quality improvement initiatives: A system‐wide embedded research partnership at Stanford Medicine

“…This was particularly relevant in gathering patient and caregiver perspectives during the pandemic when in‐person interviews in clinic were not feasible; proactive outreach with scheduled phone and video calls helped the teams obtain these perspectives for several projects. 33 , 37 , 42 , 43 Last, the ESU's collective experience and emerging expertise in this domain, resulted in a collaborative analysis of telemedicine implementation across multiple healthcare systems. 44 …”