The Pacific Island Health Care Project: Utilization of Otolaryngology and Impact on Graduate Medical Education

Abstract

Objectives: (1) Assess otolaryngology–head and neck subspecialist utilization within a large telemedicine program. (2) Examine the impact of that program on graduate medical education. Methods: A retrospective review of the Pacific Island Health Care Project records from 1998 to 2012 was performed to identify the number and type of telehealth consultations for patients with disorders of the head and neck. Consultations were categorized into diagnostic groups to evaluate referral patterns. Medical records from patients referred through the program were reviewed to determine the number and types of surgical procedures performed. Results: Four thousand telehealth consultations were sent to a single medical center with consultants representing all major medical and surgical subspecialties. A total of 730 teleconsultations were submitted for primary disorders of the head/neck, representing 18.3% of all consultations. The 3 most common reasons for teleconsultation included: benign or malignant head/neck mass (nonthyroid); thyroid mass; and cleft lip/palate. A total of 242 patients were referred for definitive surgical management. Seven hundred fifty-eight coded procedures were performed on those patients resulting in 383 key index procedures. Conclusions: Otolaryngology as a specialty is well suited for telemedicine applications. This study demonstrates a high utilization of otolaryngology indicating a high degree of referral feasibility and a high requirement for head and neck specialist consultation. This program had a large impact on graduate medical education, not only in terms of increased experience with complex patient care and operative case numbers, but also less tangible benefits relating to opportunities for residents to develop key competencies required for successful graduate medical training.