The diagnostic accuracy of telegeriatrics for the diagnosis of dementia via video conferencing
Martin-Khan, Melinda , Flicker, Leon , Wootton, Richard , Loh, Poh-Kooh , Edwards, Helen E., Varghese, Paul , Byrne, Gerard J. , Klein, Kerenaftali , & Gray, Leonard C. (2012) The diagnostic accuracy of telegeriatrics for the diagnosis of dementia via video conferencing. Journal of the American Medical Directors Association, 13(5), 487.e19-487.e24.
The suitability of video conferencing (VC) technology for clinical purposes relevant to geriatric medicine is still being established. This project aimed to determine the validity of the diagnosis of dementia via VC.
This was a multisite, noninferiority, prospective cohort study. Patients, aged 50 years and older, referred by their primary care physician for cognitive assessment, were assessed at 4 memory disorder clinics. All patients were assessed independently by 2 specialist physicians. They were allocated one face-to-face (FTF) assessment (Reference standard – usual clinical practice) and an additional assessment (either usual FTF assessment or a VC assessment) on the same day. Each specialist physician had access to the patient chart and the results of a battery of standardized cognitive assessments administered FTF by the clinic nurse. Percentage agreement (P0) and the weighted kappa statistic with linear weight (Kw) were used to assess inter-rater reliability across the 2 study groups on the diagnosis of dementia (cognition normal, impaired, or demented).
The 205 patients were allocated to group: Videoconference (n = 100) or Standard practice (n = 105); 106 were men. The average age was 76 (SD 9, 51–95) and the average Standardized Mini-Mental State Examination Score was 23.9 (SD 4.7, 9–30). Agreement for the Videoconference group (P0= 0.71; Kw = 0.52; P < .0001) and agreement for the Standard Practice group (P0= 0.70; Kw = 0.50; P < .0001) were both statistically significant (P < .05). The summary kappa statistic of 0.51 (P = .84) indicated that VC was not inferior to FTF assessment.
Previous studies have shown that preliminary standardized assessment tools can be reliably administered and scored via VC. This study focused on the geriatric assessment component of the interview (interpretation of standardized assessments, taking a history and formulating a diagnosis by medical specialist) and identified high levels of agreement for diagnosing dementia. A model of service incorporating either local or remote administered standardized assessments, and remote specialist assessment, is a reliable process for enabling the diagnosis of dementia for isolated older adults.
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|Item Type:||Journal Article|
|Keywords:||telemedicine, remote consultation, dementia, Alzheimer Disease, diagnostic accuracy|
|Subjects:||Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)|
|Divisions:||Current > QUT Faculties and Divisions > Faculty of Health|
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
|Copyright Owner:||Copyright 2012 Elsevier|
|Copyright Statement:||This is the author’s version of a work that was accepted for publication in Journal of the American Medical Directors Association. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of the American Medical Directors Association, [VOL 13, ISSUE 5, (DATE)] DOI: 10.1016/j.jamda.2012.03.004|
|Deposited On:||04 Apr 2012 10:00|
|Last Modified:||13 Sep 2013 02:09|
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