A process modelling approach to assess the impact of teledermatology deployment onto the skin tumor care pathway

• Published in: International journal of medical informatics (Shannon, Ireland) Vol. 146; p. 104361
• Main Authors: Duong, Tu Anh, Lamé, Guillaume, Zehou, Ouidad, Skayem, Charbel, Monnet, Patricia, El Khemiri, Mohammed, Boudjemil, Sonia, Hirsch, Gaëlle, Wolkenstein, Pierre, Jankovic, Marija
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2021; Elsevier
• Subjects: Access to care; Aged; Aged, 80 and over; Business administration; Care pathway; Delivery of Health Care; Dermatology; Engineering Sciences; Evaluation; Human health and pathology; Humanities and Social Sciences; Humans; Life Sciences; Non-melanoma skin cancer; Other; Process modelling; Referral and Consultation; Santé publique et épidémiologie; Skin Neoplasms - diagnosis; Skin Neoplasms - therapy; Teledermatology; Telehealth; Telemedicine; RR; Process modelling; Evaluation; Access to care; Telehealth; CI; Care pathway; Teledermatology; NMSC; TD; Telemedicine; ICT; Non-melanoma skin cancer; evaluation; telemedicine; care pathway; Processmodelling; telehealth; teledermatology; access to care; non melanoma skin cancer
• ISSN: 1386-5056; 1872-8243
• DOI: 10.1016/j.ijmedinf.2020.104361

•Teledermatology has been raised as an answer to increase access to care and decrease lead time to skin tumor management.•No data about care process after skin tumor management using teledermatology.•Process modelling has been used to assess area of improvement in healthcare systems.•Telehealth assessment has barely used process modelling approach.•Herein process modelling compared skin tumor care pathways, and highlighted that TD management did not shorten overall management process. 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. To compare conventional care pathway to teledermatology (TD) in NMSC care pathways using a process modelling approach. 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. Linear regression was performed using time between multidisciplinary consultation and surgery as outcome adjusted on sex, age and cancer type. 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). Linear 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. 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.