01647nas a2200157 4500000000100000008004100001100001400042700001000056700001600066245019000082856007900272300000800351490000600359520111000365022001401475 2015 d1 aWootton R1 aLiu J1 aBonnardot L00aRelationship between the quality of service provided through store-and-forward telemedicine consultations and the difficulty of the cases - Implications for long-term quality assurance. uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585167/pdf/fpubh-03-00217.pdf a2170 v33 a

We examined the difficulty of telemedicine cases and the quality of the resultant consultation in a mature store-and-forward telemedicine network. A random sample of 10 telemedicine cases was selected from those occurring over a 3-month period (5% of the workload) and they were scored by three experienced observers. Inter-observer agreement on the difficulty scores was poor (Fleiss's kappa = 0.18) and it was also poor on the consultation quality scores (Fleiss's kappa = 0.11). Differences between observers were minimized by consensus scoring, and the cases were re-assessed jointly by two observers. Based on the consensus scores, there was a weak negative relation between output quality and case difficulty, i.e., the more difficult cases tended to result in lower quality consultations. However, the effect was non-significant (P = 0.59) and a larger study might be helpful. In the meantime, routine monitoring of telemedicine service quality will continue in the interests of quality assurance. As yet, there is no evidence on which to base a correction for case difficulty.

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