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Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images.

Publication ,  Journal Article
Jiang, SW; Flynn, MS; Kwock, JT; Liu, B; Quow, K; Blanchard, SK; Breglio, KF; Fresco, A; Jamison, MO; Lesesky, E; Bellet, JS; Green, CL ...
Published in: JAMA Dermatol
October 1, 2022

IMPORTANCE: Patient-submitted images vary considerably in quality and usefulness. Studies that characterize patient-submitted images in a real-life setting are lacking. OBJECTIVE: To evaluate the quality and perceived usefulness of patient-submitted images as determined by dermatologists and characterize agreement of their responses. DESIGN, SETTING, AND PARTICIPANTS: This survey study included patient images submitted to the Department of Dermatology at Duke University (Durham, North Carolina) between August 1, 2018, and December 31, 2019. From a total pool of 1200 images, 10 dermatologists evaluated 200 or 400 images each, with every image being evaluated by 3 dermatologists. Data analysis occurred during the year leading up to the article being written. MAIN OUTCOMES AND MEASURES: The primary outcomes were the responses to 2 questions and were analyzed using frequency counts and interrater agreement (Fleiss κ) to assess image quality and perceived usefulness. We performed a random-effects logistic regression model to investigate factors associated with evaluators' decision-making comfort. We hypothesized that most images would be of low quality and perceived usefulness, and that interrater agreement would be poor. RESULTS: A total of 259 of 2915 patient-submitted images (8.9%) did not depict a skin condition at all. The final analysis comprised 3600 unique image evaluations. Dermatologist evaluators indicated that 1985 images (55.1%) were useful for medical decision-making and 2239 (62.2%) were of sufficient quality. Interrater agreement for a given image's diagnostic categorization was fair to substantial (κ range, 0.36-0.64), while agreement on image quality (κ range, 0.35-0.47) and perceived usefulness (κ range, 0.29-0.38) were fair to moderate. Senior faculty had higher odds of feeling comfortable with medical decision-making than junior faculty (odds ratio [OR], 3.68; 95% CI, 2.9-4.66; P < .001) and residents (OR, 5.55; 95% CI, 4.38-7.04; P < .001). Images depicting wounds (OR, 1.75; 95% CI, 1.18-2.58; P = .01) compared with inflammatory skin conditions and that were in focus (OR, 5.56; 95% CI, 4.63-6.67; P < .001) had higher odds of being considered useful for decision-making. CONCLUSIONS AND RELEVANCE: In this survey study including 10 dermatologists, a slight majority of patient-submitted images were judged to be of adequate quality and perceived usefulness. Fair agreement between dermatologists was found regarding image quality and perceived usefulness, suggesting that store-and-forward teledermatology initiatives should consider a physician's individual experiences and comfort level. The study results suggest that images are most likely to be useful when they are in focus and reviewed by experienced attending physicians for wound surveillance, but dermatologists may be burdened by irrelevant or unsuitable images.

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Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

October 1, 2022

Volume

158

Issue

10

Start / End Page

1183 / 1186

Location

United States

Related Subject Headings

  • Telemedicine
  • Skin Diseases
  • Remote Consultation
  • Humans
  • Health Personnel
  • Dermatology
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
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ICMJE
MLA
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Jiang, S. W., Flynn, M. S., Kwock, J. T., Liu, B., Quow, K., Blanchard, S. K., … Nicholas, M. W. (2022). Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images. JAMA Dermatol, 158(10), 1183–1186. https://doi.org/10.1001/jamadermatol.2022.2815
Jiang, Simon W., M Seth Flynn, Jeffery T. Kwock, Beiyu Liu, Krystina Quow, Sarah K. Blanchard, Kimberly F. Breglio, et al. “Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images.JAMA Dermatol 158, no. 10 (October 1, 2022): 1183–86. https://doi.org/10.1001/jamadermatol.2022.2815.
Jiang SW, Flynn MS, Kwock JT, Liu B, Quow K, Blanchard SK, et al. Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images. JAMA Dermatol. 2022 Oct 1;158(10):1183–6.
Jiang, Simon W., et al. “Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images.JAMA Dermatol, vol. 158, no. 10, Oct. 2022, pp. 1183–86. Pubmed, doi:10.1001/jamadermatol.2022.2815.
Jiang SW, Flynn MS, Kwock JT, Liu B, Quow K, Blanchard SK, Breglio KF, Fresco A, Jamison MO, Lesesky E, Bellet JS, Green CL, Shearer SM, Nicholas MW. Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images. JAMA Dermatol. 2022 Oct 1;158(10):1183–1186.

Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

October 1, 2022

Volume

158

Issue

10

Start / End Page

1183 / 1186

Location

United States

Related Subject Headings

  • Telemedicine
  • Skin Diseases
  • Remote Consultation
  • Humans
  • Health Personnel
  • Dermatology
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences