Risk factors for loss of follow-up after asynchronous dermatology eConsult concerning for skin cancer

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 o ce followup 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-o ce appointment, referral status, and health care utilization. In-o ce follow-up appointments were de ned as completed, cancelled/no-show or no-contact. 667 patients with a diagnosis of D48.5 were identi ed as having completed an eConsult. 427 (64%) patients had a documents 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 signi cantly associated with documentation of phone/electronic message in the univariate and multivariate model. 429 (84%) patients had a dermatology o ce follow-up encounter while 82 (16%) had no appointment scheduled. Language spoken, referral status and race were signi cant in the univariate model, though race was the only signi cant 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.

Using the RE-AIM framework to assess national teledermatology expansion

“…Our evaluation's finding of lower rates of skin cancer diagnoses for teledermatology compared with in-person and higher rates of a code for NUB is understandable, given that most teledermatology encounters are consultations to evaluate new, undiagnosed skin concerns. Receiving a NUB diagnosis typically leads to a follow-up in-person encounter ( 23 ). We surmise that examining follow-up encounters resulting from receiving a NUB code would reveal a high detection rate of skin cancers in these encounters.…”