title: Changes in diagnosis, treatment, and clinical improvement among patients receiving telemedicine consultations.
abstract: The aim of this study was to determine whether outpatient telemedicine specialty consultations to primary care clinicians result in changes in a patient's diagnosis, treatment management, and clinical outcomes. Medical records of patients who received two or more clinical telemedicine consultations in dermatology, psychiatry, and endocrinology were evaluated in a nonconcurrent retrospective analysis. Three indicators were used to measure changes in the processes of care and clinical outcomes: change in diagnosis, change in treatment, and patient clinical improvement. A retrospective review of 223 individual telemedicine patient medical records was conducted. Specialty telemedicine consultations were found to result in changes in diagnoses in 48% of the cases, changes in treatment therapy in 81.6% of the cases, and clinical improvement in 60.1%. These results are consistent with previous literature that has assessed changes in processes of care and outcomes from face-to-face specialty consultations in outpatient clinics. Changes in diagnosis and treatment therapy were found to be associated with clinical improvement with odds ratios (ORs) of 2.66 (95% confidence interval [CI]: 1.47-4.83) and 11.22 (95% CI: 4.49-31.48), respectively. This study found that telemedicine consultations resulted in changes in diagnosis and treatment regimens and also are associated with clinical improvements.
authors.affiliation: Department of Pediatrics, University of California Davis Health System, Sacramento, California 95817, USA. jpmarcin@ucdavis.edu
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Cole
authors.forename: Robin M
authors.initials: RM
authors.lastname: Knuttel
authors.forename: Donald M
authors.initials: DM
authors.lastname: Hilty
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Prescott
authors.forename: Martha M
authors.initials: MM
authors.lastname: Daschbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002648:Child; D002675:Child, Preschool; D003933:Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011787:Quality of Health Care; D012017:Referral and Consultation; D017216:Telemedicine; D013812:Therapeutics