Background

Teledermatology was raised as a potential answer to increase access and decrease delay for skin cancer management. However, its influence on non-melanoma skin cancer (NMSC) care pathway has never been studied.

Objectives

To compare conventional care pathway to teledermatology (TD) in NMSC care pathways using a process modelling approach.

Patients and Methods

A period study including three groups was conducted in a department of dermatology. During the first period from January till February 2013 a NMSC care pathway was mapped for a group a prior TD integration. During the second period from September 2016 till October 2018, the NMSC care pathway was determined for patients managed by a conventional care process and after TD diagnosis. Patients characteristics, type of tumors and processes were compared using time as a key performance indicator. Mean were reported with their ± SD. Logistic regression was performed using time between multidisciplinary consultation and surgery as outcome adjusted on sex, age and cancer type.

Results

During the first period (prior to TD) 89 NMSC patients were managed (mean age = 76 yr old ± 13) during the second period, 36 patients NMSC were managed after TD, mean age of 89 years old ± 6 and 954 patients in a conventional process, mean age of 78 years old ±12. In comparison between the two periods patient’s age, sex and cancer distribution significantly differed while the rate of surgery was not significantly different (p = 0.967). Logistic multivariate regression using time between multidisciplinary consultation and surgery as outcome adjusted on sex age and cancer type displayed that during the second period patients in the TD group spent 17.6 days more [0.98,34.25] while patient in the conventional care process group had 9.8 days [1.85,17.74] more than patient in the study period 1, (p = 0.04, p = 0.02) without significant difference for age and sex (p = 0.29, p = 0.51). Patients with a SCC had a decreased time between multidisciplinary consultation and surgery of -12.97 days [-17.43, -8.5], p<10^-3.

Conclusion

Interestingly, patients managed by TD were significantly older than those managed using a conventional care pathway. Unexpectedly their total time spent in the process was not shorter. The results of this analysis illustrated the interest of using process modelling approach to assess the impact of a healthcare innovation integration and to further rethink coordination and care pathways for NSMC post TD.

中文翻译：

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一种评估远程皮肤病学部署对皮肤肿瘤护理途径影响的过程建模方法

背景

远程皮肤病学被认为是增加皮肤癌治疗的机会并减少其延误的潜在答案。但是，其对非黑素瘤皮肤癌（NMSC）护理途径的影响尚未进行过研究。

目标

使用过程建模方法将常规护理途径与NMSC护理途径中的远程皮肤科（TD）进行比较。

患者和方法

在皮肤科进行了包括三组的定期研究。在从2013年1月到2013年2月的第一个阶段，为之前进行过TD整合的人群绘制了NMSC护理路径。在2016年9月至2018年10月的第二个阶段中，确定了通过常规护理流程和TD诊断后的患者的NMSC护理途径。使用时间作为关键绩效指标比较了患者的特征，肿瘤类型和过程。均数用其±SD报告。使用多学科咨询和手术之间的时间进行Logistic回归，并根据性别，年龄和癌症类型调整结局。

结果

在第一个阶段（TD之前），在第二阶段管理了89例NMSC患者（平均年龄= 76岁±13岁），在TD之后对36例NMSC进行了治疗，平均年龄为89岁±6岁，在954例中接受了954例患者传统方法，平均年龄为78岁±12。在两个时期的比较中，患者的年龄，性别和癌症分布显着不同，而手术率没有显着差异（p = 0.967）。使用多学科咨询和手术之间的时间进行逻辑多变量回归，并根据性别和癌症类型对结局进行了调整，结果表明，在第二阶段，TD组的患者花费了17.6天[0.98,34.25]，而常规护理过程组的患者花费了9.8天[1.85,17.74]在研究阶段1中比患者多（p = 0.04，p = 0。02）在年龄和性别上无显着差异（p = 0.29，p = 0.51）。SCC患者在多学科咨询和手术之间的时间缩短了-12.97天[-17.43，-8.5]，p <10^-3。

结论

有趣的是，由TD治疗的患者明显比使用传统护理途径治疗的患者大。没想到他们在该过程中花费的总时间并不短。分析结果表明，使用过程建模方法评估医疗保健创新整合的影响并进一步重新考虑TD后NSMC的协调和护理途径的兴趣。