The Hub-and-Spoke Management of Glaucoma

Nuzzi, Raffaele; Nuzzi, Alessia

doi:10.3389/fnins.2020.00180

Cited by 9 publications

(7 citation statements)

References 53 publications

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“…Primary and secondary prevention is implemented at the local level, through territorial healthcare and screening programs, while tertiary prevention occurs in the ophthalmology departments and in the specialized centers for glaucoma, once the diagnosis has been made. It is equally important to establish a communication network that can correctly insert and guide patients within this path, first of prevention and then of treatment ( Figure 1 ) [ 40 ].…”

Section: Current Applications Of Teleophthalmologymentioning

confidence: 99%

Teleophthalmology Service: Organization, Management, Actual Current Applications, and Future Prospects

Nuzzi

Bovone

Maradei

et al. 2021

International Journal of Telemedicine and Applications

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Teleophthalmology (TO) consists of the clinical and therapeutic approach to the patient (e-Health) using informatic and telecommunication systems. Already widespread worldwide, it aims to improve patient care, expand the healthcare offer, and access to medical care by reducing overall costs. Despite the organizational, legal, and management difficulties, the substantial economic investments necessary for the start-up of equipped structures and efficient territorial services are amply rewarded by economic results and optimal services for professionals and patients. This review specifically analyses the current scenario of teleophthalmology, the points for and against its application in different sociodemographic realities, and in particular, the current and future fields of use.

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Section: Current Applications Of Teleophthalmologymentioning

confidence: 99%

Teleophthalmology Service: Organization, Management, Actual Current Applications, and Future Prospects

Nuzzi

Bovone

Maradei

et al. 2021

International Journal of Telemedicine and Applications

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“…Different telemedicine projects propose generic solutions with static Hub and Spoke architecture [14], [15], in which the teleconsultation and the exchange of clinical data and information take place through traditional clinical assessment, in absence of a single management platform and digitalized telemedicine pathways for the real time sharing of reports, diagnostic images and documents. To overcome a typical static organization, the HINT project envisages the use of a workflow engine for the complete routing and management of the consultation request and parameter monitoring to the appropriate and available Hub.…”

Section: Motivationmentioning

confidence: 99%

A Cloud Telemedicine Platform Based On Workflow Management System: A Review Of An Italian Case Study

Mitrano¹,

Caforio²,

Calogiuri³

et al. 2022

Adv. sci. technol. eng. syst. j.

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The paper aims to describe a new technological and organizational approach in order to manage teleconsultation and telemonitoring processes involving a Physician, who remotely interacts with one or more Specialists, in order to evaluate and discuss the specific clinical conditions of a patient, based primarily on the sharing of digital clinical data, reports and diagnostic images. In the HINT project (Healthcare INtegration in Telemedicine), a teleconsultation and telemonitoring cloud platform has been developed using a Hub and Spoke architecture, based on a Business Process Management System (BPMS). The specialized clinical centres (Hubs) operate in connection with the territorial hospital centres (Spokes), which receive specific diagnostic consultations and telemonitoring data from the appropriate Specialist, supported by advanced AI systems. The developed platform overcomes the concepts of a traditional and fragmented teleconsultation and consequently the static organization of Hubs and Spokes, evolving towards an integrated clinical workflow management. The project platform adopts international healthcare standards, such as HL7 FHIR, IHE (XDS and XDW) and DICOM for the acquisition and management of healthcare data and diagnostic images. A Workflow Management System implemented in the platform allows to manage multiple and contemporaneous processes through a single platform, correctly associating the tasks to the Physicians responsible for their execution, monitoring the status of the health activities and managing possible clinical issues.

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“… 2 The care of patients with glaucoma or those in whom glaucoma is suspected represents a significant burden to healthcare systems worldwide. 3 In 2005, the direct and indirect costs of glaucoma to the Australian healthcare system was estimated to be A$355 million, projected to increase to A$784 million by 2025. 4 In the United States, costs have been estimated to be greater than US$2.9 billion.…”

Section: Introductionmentioning

confidence: 99%

Glaucoma Suspects: The Impact of Risk Factor-Driven Review Periods on Clinical Load, Diagnoses, and Healthcare Costs

Phu

Masselos

Sullivan-Mee³

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose To model the healthcare impact (clinical attendance time and financial cost) and clinical outcomes (glaucoma diagnoses) of different risk factor–driven review frequencies for glaucoma suspect patients up until the point of discharge or diagnosis. Methods Medical records of 494 glaucoma suspects were examined to extract the clinical diagnosis. Two criteria for review periods were defined, based on contrasting stringency from established clinical guidelines: American Academy of Ophthalmology (AAO), more stringent/less frequent; and the Australian National Health and Medical Research Council (NHMRC), less stringent/more frequent. We used these data to model patient outcomes and healthcare costs using a Markov model. Results The less stringent/more frequent criterion resulted in more high-risk glaucoma suspects requiring more frequent review compared with the more stringent/less frequent criterion. Across the 15 Markov cycles (7.5 years), the less stringent/more frequent review criterion resulted in 6.6% more diagnoses and fewer overall clinical visits (14.7%) and reduced cost per diagnosis by 12% to 32% ( P < 0.0001). The number of glaucoma diagnoses made using each criterion converged at 2.5 to 3 years. Conclusions The stringency of risk assessments for glaucoma suspects impacts review periods and therefore clinical load, healthcare costs, and diagnosis rates. Using current testing methods, more frequent review periods appear advantageous for diagnostic efficiency, with both lower clinic load and lower cost up until the point of discharge or glaucoma diagnosis. Translational Relevance A less stringent criterion for assessing the risk of developing glaucoma potentially offers a more cost-effective method for reviewing glaucoma suspects, especially within the first 2.5 years.

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The Hub-and-Spoke Management of Glaucoma

Cited by 9 publications

References 53 publications

Teleophthalmology Service: Organization, Management, Actual Current Applications, and Future Prospects

Teleophthalmology Service: Organization, Management, Actual Current Applications, and Future Prospects

A Cloud Telemedicine Platform Based On Workflow Management System: A Review Of An Italian Case Study

Glaucoma Suspects: The Impact of Risk Factor-Driven Review Periods on Clinical Load, Diagnoses, and Healthcare Costs

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