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Epi Special Seminar

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Tuesday, May 3, 2011
William H. Foege Genome Sciences Building (GNOM) S060
3:30 to 4:50pm

Designing and Evaluating a Tele-Dermatology Project for the Pacific NW

Reiber  

Gayle Reiber, PhD
Professor, Departments of Health Services and Epidemiology

Senior VA Career Scientist, HSR&D,  and Center of Excellence for Limb Loss Prevention and Prosthetics Engineering, VA Puget Sound Health Care System, Seattle, WA

 

Dr. Reiber is an epidemiologist, health services researcher and Senior VA Career Scientist in the Health Services Research and Development Center of Excellence, and the VA Center of Excellences for Limb Loss Prevention and Prosthetics Engineering, VA Puget Sound Health Care System, Seattle. Dr. Reiber received her MPH from Johns Hopkins University and her PhD from the University of Washington. She is a Professor in the Department of Health Services and Epidemiology at the University of Washington.

Dr. Reiber’s major research interests are diabetes and the prevention and treatment of lower limb wounds. Her work involves national surveys and data collection involving service members and veterans with traumatic limb loss from Vietnam, Afghanistan and Iraqi. Her research also addresses diabetes self-management. Dr Reiber is Co-PI of the VISN 20 Tele-Dermatology project, a 40 site project providing and evaluating dermatology care for rural veterans from Alaska to Northern California on the west and Montana on the East. She is responsible for the HSR&D Post-Doctoral training programs at the VA Puget Sound Health Care System, and mentors pre and post doctoral fellows and junior faculty members. She co-teaches the grant writing course for the Epidemiology Department and directs the PhD and Post-Doctoral Admissions Program for the Department of Health Services.  

Abstract

Background:
Dermatology is an often-absent, but always-needed component of medical care in rural areas.  Many skin problems such as skin cancers, psoriasis, and infections require diagnosis by a dermatologist. The demand for dermatology care by veterans greatly exceeds the current capacity in the Pacific Northwest.  In 2009 Drs. Gregory Raugi and Gayle Reiber initiated a project to expand dermatology capacity and improve access to specialist dermatology care for rural veterans through a store-and-forward Tele-dermatology Project.  The Project involves rural primary care providers and imagers taking lesion photographs and sending consults through the VA electronic medical record to a reading center in Seattle. A Board Certified Dermatologists makes treatment and follow-up recommendations for the rural primary care providers to follow.  

  1. Objectives:
    To determine the safety, timeliness, and outcomes of a VA Tele-dermatology consultation store and forward system
  2. To facilitate dermatology skill development in rural primary care providers provides through structured education and training
  3. To evaluate patient satisfaction, project effectiveness and cost savings

 

Methods:
Implementation of this VA Project began in July 2009. A system for developing and advancing the skills of local primary providers and support staff was followed by establishing new rural tele-dermatology clinics and services. Each rural site differs but all follow the same Policy and Procedure Manual.  Numerous quality control mechanisms are built into the care process.


Results:
Since July 2009, 7,449 tele-dermatology consults on 4,900 unique veterans were received from 145 primary care providers. The average time to consult response is 1.25 days. Approximately 38% of the consults result in patient reassurance and/or simple prescriptions. Very minor procedures are provided to 19% of patients, major medications requiring monitoring are provided to 8% of patients and major dermatology procedures are indicated for 35% of patients.  To date 886 non-melanoma skin cancers and 45 melanomas have been detected.

Evaluation
The presentation will summarize evaluation findings to date.  

 

Updated on April 11, 2011