Leonie Thijssing1, Job P van der Heijden2, Niels H Chavannes3, Christian F Melissant4, Monique W M Jaspers5, Leonard Witkamp2. 1. Center of Human Factors Engineering of Health Information Technology HITlab, Department of Medical Informatics, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands; KSYOS Health Management Research, Amstelveen, The Netherlands. Electronic address: l.thijssing@amc.uva.nl. 2. KSYOS Health Management Research, Amstelveen, The Netherlands. 3. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. 4. Department of Pulmonology, Spaarne Hospital, Hoofddorp, The Netherlands. 5. Center of Human Factors Engineering of Health Information Technology HITlab, Department of Medical Informatics, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Interpreting spirometry results has proven challenging in primary care practice, among others potentially leading to under- and misdiagnosis of COPD. In telepulmonology a general practitioner (GP) digitally consults a pulmonologist to support the interpretation of spirometry results. This study assessed the effect of telepulmonology on quality and efficiency of care. METHODS: Quality of care was measured by five indicators, among others the percentage of TelePulmonology Consultations (TPCs) sent by GPs for advice, percentage of those TPCs resulting in a physical referral, and educational effect of telepulmonology as experienced by GPs. Efficiency was defined as the percentage of prevented unnecessary physical referrals of patients to the pulmonologist. RESULTS: Between April 2009 and November 2012 1.958 TPCs were sent by 158 GPs to 32 pulmonologists. Sixty-nine percent of the TPCs were sent for advice. Based on the advice of the pulmonologist 18% of these TPCs led to a physical referral of patients who would not have been referred without telepulmonology. Thirty-one percent of the TPCs were intended to prevent a physical referral, 68% of these actually prevented a physical referral to a pulmonologist. CONCLUSION: The results show telepulmonology can contribute to quality of care by supporting GPs and can additionally prevent unnecessary physical referrals.
BACKGROUND: Interpreting spirometry results has proven challenging in primary care practice, among others potentially leading to under- and misdiagnosis of COPD. In telepulmonology a general practitioner (GP) digitally consults a pulmonologist to support the interpretation of spirometry results. This study assessed the effect of telepulmonology on quality and efficiency of care. METHODS: Quality of care was measured by five indicators, among others the percentage of TelePulmonology Consultations (TPCs) sent by GPs for advice, percentage of those TPCs resulting in a physical referral, and educational effect of telepulmonology as experienced by GPs. Efficiency was defined as the percentage of prevented unnecessary physical referrals of patients to the pulmonologist. RESULTS: Between April 2009 and November 2012 1.958 TPCs were sent by 158 GPs to 32 pulmonologists. Sixty-nine percent of the TPCs were sent for advice. Based on the advice of the pulmonologist 18% of these TPCs led to a physical referral of patients who would not have been referred without telepulmonology. Thirty-one percent of the TPCs were intended to prevent a physical referral, 68% of these actually prevented a physical referral to a pulmonologist. CONCLUSION: The results show telepulmonology can contribute to quality of care by supporting GPs and can additionally prevent unnecessary physical referrals.
Authors: Rashid L Bashshur; Gary W Shannon; Brian R Smith; Dale C Alverson; Nina Antoniotti; William G Barsan; Noura Bashshur; Edward M Brown; Molly J Coye; Charles R Doarn; Stewart Ferguson; Jim Grigsby; Elizabeth A Krupinski; Joseph C Kvedar; Jonathan Linkous; Ronald C Merrell; Thomas Nesbitt; Ronald Poropatich; Karen S Rheuban; Jay H Sanders; Andrew R Watson; Ronald S Weinstein; Peter Yellowlees Journal: Telemed J E Health Date: 2014-06-26 Impact factor: 3.536