Abstract
Asynchronous electronic consultations (e-consults) can be a useful tool for the screening of cutaneous lesions, but may offer a malpractice risk. We characterized factors affecting initial eConsult office follow-up in a cohort of patients with documented neoplasm of uncertain behavior. Patients with an ICD 10 code of neoplasm with uncertain behavior (D48.5) at The Ohio State University that received an E-consult order from May 2017 to May 2021 were queried. Information collected included patient demographics, status of follow-up in-office appointment, referral status, and health care utilization. In-office follow-up appointments were defined as completed, cancelled/no-show or no-contact. 667 patients with a diagnosis of D48.5 were identified as having completed an eConsult. 427 (64%) patients had a documented phone/electronic message notifying the patient of the results of the eConsult. Year of encounter (0.88 [0.79–0.97]) and number of previously completed ambulatory visits (0.86 [0.77–0.96]) were significantly associated with documentation of phone/electronic message in the univariate and multivariate model. 429 (84%) patients had a dermatology office follow-up encounter while 82 (16%) had no appointment scheduled. Language spoken, referral status and race were significant in the univariate model, though race was the only significant variable in the multivariate model (P < 0.003). Asynchronous electronic consults to assess possible cutaneous neoplasms is an important tool for population screening of skin cancer. Dermatologists and health systems implementing an eConsult model for screening purposes should be aware of risk factors for loss of follow-up. Additional systems need to be implemented to ensure minorities and non-native English speakers are obtaining adequate dermatologic care.
References
Wang RF, Trinidad J, Lawrence J et al (2020) Improved patient access and outcomes with the integration of an eConsult program (teledermatology) within a large academic medical center. J Am Acad Dermatol 83(6):1633–1638. https://doi.org/10.1016/j.jaad.2019.10.053
Fogel AL, Lacktman NM, Kvedar JC (2021) Skin cancer telemedicine medical malpractice risk. JAMA Dermatol 157(7):870. https://doi.org/10.1001/jamadermatol.2021.1475
Korta DZ, Saggar V, Wu TP, Sanchez M (2014) Racial differences in skin cancer awareness and surveillance practices at a public hospital dermatology clinic. J Am Acad Dermatol 70(2):312–317. https://doi.org/10.1016/j.jaad.2013.10.030
Agbai ON, Buster K, Sanchez M et al (2014) Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol 70(4):748–762. https://doi.org/10.1016/j.jaad.2013.11.038
Funding
None.
Author information
Authors and Affiliations
Contributions
SH and BK wrote the main manuscript text, prepared the figures, and performed data analysis. All authors reviewed the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Ethical approval
IRB approval status: Reviewed and approved by The Ohio State University IRB Study ID # 2022H0029.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Himed, S., Levine, E., Trinidad, J.C. et al. Risk factors for loss of follow-up after asynchronous dermatology eConsult concerning for skin cancer. Arch Dermatol Res 315, 669–672 (2023). https://doi.org/10.1007/s00403-022-02419-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-022-02419-y