title: Telepulmonology: effect on quality and efficiency of care.
abstract: BACKGROUND
  Interpreting spirometry results has proven challenging in primary care practice, among others potentially leading to under- and misdiagnosis of COPD. In telepulmonology a general practitioner (GP) digitally consults a pulmonologist to support the interpretation of spirometry results. This study assessed the effect of telepulmonology on quality and efficiency of care.
  
  
  METHODS
  Quality of care was measured by five indicators, among others the percentage of TelePulmonology Consultations (TPCs) sent by GPs for advice, percentage of those TPCs resulting in a physical referral, and educational effect of telepulmonology as experienced by GPs. Efficiency was defined as the percentage of prevented unnecessary physical referrals of patients to the pulmonologist.
  
  
  RESULTS
  Between April 2009 and November 2012 1.958 TPCs were sent by 158 GPs to 32 pulmonologists. Sixty-nine percent of the TPCs were sent for advice. Based on the advice of the pulmonologist 18% of these TPCs led to a physical referral of patients who would not have been referred without telepulmonology. Thirty-one percent of the TPCs were intended to prevent a physical referral, 68% of these actually prevented a physical referral to a pulmonologist.
  
  
  CONCLUSIONS
  The results show telepulmonology can contribute to quality of care by supporting GPs and can additionally prevent unnecessary physical referrals.
authors.affiliation: Center of Human Factors Engineering of Health Information Technology HITlab, Department of Medical Informatics, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands; KSYOS Health Management Research, Amstelveen, The Netherlands. Electronic address: l.thijssing@amc.uva.nl.
authors.forename: Leonie
authors.initials: L
authors.lastname: Thijssing
authors.affiliation: KSYOS Health Management Research, Amstelveen, The Netherlands.
authors.forename: Job P
authors.initials: JP
authors.lastname: van der Heijden
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Chavannes
authors.affiliation: Department of Pulmonology, Spaarne Hospital, Hoofddorp, The Netherlands.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Melissant
authors.affiliation: Center of Human Factors Engineering of Health Information Technology HITlab, Department of Medical Informatics, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Monique W M
authors.initials: MW
authors.lastname: Jaspers
authors.affiliation: KSYOS Health Management Research, Amstelveen, The Netherlands.
authors.forename: Leonard
authors.initials: L
authors.lastname: Witkamp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D058006:General Practice / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D015272:Pulmonary Medicine / Q000379:methods*; D011787:Quality of Health Care; D012017:Referral and Consultation; D013147:Spirometry / Q000379:methods / Q000592:standards; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: Efficiency; Pulmonary medicine; Quality improvement; Telemedicine