title: An international pilot study of asynchronous teleconsultation for oropharyngeal dysphagia.
abstract: We investigated whether an expert's consultation provided via telemedicine could improve the quality of care for patients with dysphagia. A trained clinician completed videofluoroscopic swallowing studies (VFSS) of 17 consecutive patients in a Greek hospital. The videofluoroscopic images were then stored on a website for independent review by an expert Speech and Language Pathologist in the US. An extra Rater evaluated 20% of all data for additional reliability testing. Eight diagnostic indicators of swallowing impairment and an overall subjective severity index were recorded for each study. Clinicians were also asked to choose from ten common treatment options for patients with dysphagia. There was good inter-rater agreement for most of the diagnostic indicators examined (ranging from 78% to 90%; kappa = 0.52-0.71) between all three Raters. Agreement on overall severity ratings was exact for more than half of the patients and within one-point on the 4-point scale for all other patients except one. However, the quality of care would have been substandard for more than half of the patients if teleconsultation had not been employed. In settings where a swallowing expert is not available and real-time telemedicine is not feasible, the use of asynchronous teleconsultation can produce better quality of care for patients with dysphagia.
authors.affiliation: Program of Speech and Language Pathology, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA. malandraki@tc.columbia.edu
authors.forename: Georgia A
authors.initials: GA
authors.lastname: Malandraki
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Markaki
authors.forename: Voula C
authors.initials: VC
authors.lastname: Georgopoulos
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Bauer
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kalogeropoulos
authors.forename: Serafim
authors.initials: S
authors.lastname: Nanas
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011446:Prospective Studies; D011787:Quality of Health Care; D019114:Remote Consultation / Q000592:standards*; D015203:Reproducibility of Results; D012720:Severity of Illness Index