Partnering with a senior living community to optimise teledermatology via full body skin screening during the COVID‐19 pandemic: A pilot programme

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Abstract

<div class="section"> <a class="named-anchor" id="ski2141-sec-0001">  </a> <h5 class="section-title" id="d8017701e249">Background</h5> <p id="d8017701e251">Elderly patients in senior communities faced high barriers to care during the COVID‐19 pandemic, including increased vulnerability to COVID‐19, long quarantines for clinic visits, and difficulties with telemedicine adoption. </p> </div><div class="section"> <a class="named-anchor" id="ski2141-sec-0002">  </a> <h5 class="section-title" id="d8017701e254">Objective</h5> <p id="d8017701e256">To pilot a new model of dermatologic care to overcome barriers for senior living communities during the COVID‐19 pandemic and assess patient satisfaction. </p> </div><div class="section"> <a class="named-anchor" id="ski2141-sec-0003">  </a> <h5 class="section-title" id="d8017701e259">Methods</h5> <p id="d8017701e261">From 16 November 2020 to 9 July 2021, this quality improvement programme combined in‐residence full body imaging with real‐time outlier lesion identification and virtual teledermatology. Residents from the Sequoias Portola Valley Senior Living Retirement Community (Portola Valley, California) voluntarily enroled in the Stanford Skin Scan Programme. Non‐physician clinical staff with a recent negative COVID‐19 test travelled on‐site to obtain in‐residence full body photographs using a mobile app‐based system on an iPad called SkinIO that leverages deep learning to analyse patient images and suggest suspicious, outlier lesions for dermoscopic photos. A single dermatologist reviewed photographs with the patient and provided recommendations via a video visit. Objective measures included follow‐up course and number of skin cancers detected. Subjective findings were obtained through patient experience surveys. </p> </div><div class="section"> <a class="named-anchor" id="ski2141-sec-0004">  </a> <h5 class="section-title" id="d8017701e264">Results</h5> <p id="d8017701e266">Twenty‐seven individuals participated, three skin cancers were identified, with 11 individuals scheduled for a follow up in‐person visit and four individuals starting home treatment. Overall, 88% of patients were satisfied with the Skin Scan programme, with 77% likely to recommend the programme to others. 92% of patients agreed that the Skin Scan photographs were representative of their skin. In the context of the COVID‐19 pandemic, 100% of patients felt the process was safer or comparable to an in‐person visit. Despite overall appreciation for the programme, 31% of patients reported that they would prefer to see dermatologist in‐person after the pandemic. </p> </div><div class="section"> <a class="named-anchor" id="ski2141-sec-0005">  </a> <h5 class="section-title" id="d8017701e269">Conclusions</h5> <p id="d8017701e271">This programme offers a framework for how a hybrid skin scan programme may provide high utility for individuals with barriers to accessing in‐person clinics. </p> </div><p class="first" id="d8017701e274"> <div class="boxed-text panel" id="d8017701e276"> <a class="named-anchor" id="d8017701e276">  </a> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/54831f72-88f9-43f6-bca5-9f6e59e97650/PubMedCentral/image/SKI2-9999-0-g004.jpg"/> </div> <div class="panel-content"/> </div> </p>

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Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012.

Howard W Rogers, Martin Weinstock, Steven Feldman … (2015)

Understanding skin cancer incidence is critical for planning prevention and treatment strategies and allocating medical resources. However, owing to lack of national reporting and previously nonspecific diagnosis classification, accurate measurement of the US incidence of nonmelanoma skin cancer (NMSC) has been difficult.

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Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors

Debra Patt, Lúcio Gordan, Michael Diaz … (2020)

PURPOSE While the immediate care and access disruptions associated with the COVID-19 pandemic have received growing attention in certain areas, the full range of gaps in cancer screenings and treatment is not yet well understood or well documented throughout the country comprehensively. METHODS This study used a large medical claims clearinghouse database representing 5%-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the US cancer population, including identification of new patients, gaps in access to care, and disruption of treatment journeys. RESULTS In March-July 2020, in comparison with the baseline period of March-July 2019, there is a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation by cancer type and site of service. At the peak of the pandemic in April, screenings for breast, colon, prostate, and lung cancers were lower by 85%, 75%, 74%, and 56%, respectively. Significant utilization reductions were observed in April for hospital outpatient evaluation and management (E&M) visits (−74%), new patient E&M visits (−70%), and established patient E&M visits (−60%). A decrease in billing frequency was observed for the top physician-administered oncology products, dropping in both April (−26%) and July (−31%). Mastectomies were reduced consistently in April through July, with colectomies similarly reduced in April and May and prostatectomies dipping in April and July. CONCLUSION The current impact of the COVID-19 pandemic on cancer care in the United States has resulted in decreases and delays in identifying new cancers and delivery of treatment. These problems, if unmitigated, will increase cancer morbidity and mortality for years to come.

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The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States: A simulation estimate of the direct medical costs and health care resource use associated with COVID-19 infections in the United States.

Sarah Bartsch, Marie Ferguson, James McKinnell … (2020)

With the coronavirus disease 2019 (COVID-19) pandemic, one of the major concerns is the direct medical cost and resource use burden imposed on the US health care system. We developed a Monte Carlo simulation model that represented the US population and what could happen to each person who got infected. We estimated resource use and direct medical costs per symptomatic infection and at the national level, with various "attack rates" (infection rates), to understand the potential economic benefits of reducing the burden of the disease. A single symptomatic COVID-19 case could incur a median direct medical cost of $3,045 during the course of the infection alone. If 80 percent of the US population were to get infected, the result could be a median of 44.6 million hospitalizations, 10.7 million intensive care unit (ICU) admissions, 6.5 million patients requiring a ventilator, 249.5 million hospital bed days, and $654.0 billion in direct medical costs over the course of the pandemic. If 20 percent of the US population were to get infected, there could be a median of 11.2 million hospitalizations, 2.7 million ICU admissions, 1.6 million patients requiring a ventilator, 62.3 million hospital bed days, and $163.4 billion in direct medical costs over the course of the pandemic.