Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities.
To assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support. Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine. Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms, photo/video documentation, and medical records using two structured implicit review instruments. Among the 183 patients included in the study, 101 (55.2%) children were evaluated at telemedicine hospitals and 82 (44.8%) were evaluated at comparison hospitals. Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam, the genital exam, documentation of examination findings, the overall assessment, and the summed total quality score (p<0.05 for each). Evaluation of the photos/videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo/video quality, completeness of the examination, and the summed total completeness and accuracy score (p<0.05 for each). Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations, more complete examinations, and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support.
Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA 95817, USA.
Sheridan
S
Miyamoto
Department of Pediatrics, Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA 95817, USA.
Madan
M
Dharmar
Mark Twain Medical Center, Calaveras County SART Team, 768 Mountain Ranch Road, San Andreas, CA 95249, USA.
Cathy
C
Boyle
Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA 95817, USA.
Nikki H
NH
Yang
Washoe County CARES Program, Northern Nevada Medical Center, 2375 E. Prater Way, Sparks, NV 89434, USA.
Kristen
K
MacLeod
California Department of Public Health Maternal, Child & Adolescent Health Program, MS 8305, P.O. Box 997420, Sacramento, CA 95899-7420, USA.
Kristen
K
Rogers
Center for Health and Technology, Department of Family and Community Medicine, University of California Davis, 4610 X Street, Sacramento, CA 95817, USA.
Thomas
T
Nesbitt
Department of Pediatrics, Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA 95817, USA.
James P
JP
Marcin
D000293:Adolescent; D002140:California; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D005554:Forensic Medicine / Q000379:methods / Q000592:standards*; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D012423:Rural Health; D017216:Telemedicine / Q000592:standards*
Forensic medicine; Forensic nursing; Pediatrics; Quality of healthcare; Rural health; Sexual abuse; Sexual assault; Sexual violence; Telehealth; Telemedicine