Teledermatology to Facilitate Patient Care Transitions from Inpatient to Outpatient Dermatology: a Mixed Methods Evaluation (Preprint)

Abstract

Both clinicians and patients have increasingly turned to telemedicine to improve access to care, even in physical exam dependent specialties like dermatology. However, little is known whether teledermatology supports effective and timely transitions from inpatient to outpatient care, a common care coordination gap.

Using mixed methods, we sought to evaluate how teledermatology use affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care.

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-up within 90 and 14 days post-discharge across three phases: (1) June-September 2019 (pre-teledermatology), (2) June-September 2020 (early teledermatology), (3) February-May 2021 (sustained teledermatology). Time from discharge to scheduling and completion of patient’s follow-up visit for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions on teledermatology for post-discharge patients.

The clinic’s capacity to provide follow-up to patients transitioning from inpatient care increased by 36% when teledermatology services were introduced; more patients completed follow-up within 90 days post-discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). During early teledermatology use, 61% (n=62) of follow-ups were conducted via video. This decreased significantly to 47% (n=47) 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 followed up within the recommended 14 days post-discharge did not differ significantly between video and in-clinic visits during the early (53% vs. 38%; P = .15) or sustained (51% vs. 49%; P = .29) teledermatology periods. Interviewees agreed that teledermatology will continue to be offered. Most considered post-discharge follow-up patients to be ideal candidates for teledermatology since they had had a recent in-person assessment and might have difficulty attending in-clinic visits due to 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.

Teledermatology could be an important tool in maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during a pandemic, although timeliness of care transitions were not improved. Ultimately, the care modality should be determined in communication with patients to incorporate their and their family/caregivers’ preferences.