Team-Based Connected Health to Improve Access and Outcomes in Atopic Dermatitis

基于团队的互联健康可改善特应性皮炎的可及性和结果

• 批准号: 10341132
• 负责人: April W Armstrong
• 金额: $ 67.61万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-05 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10341132
• 关键词: Address; Adopted; Adult; Affect; Area; Atopic Dermatitis; Caring; Child; Childhood; Chronic; Chronic Disease; Clinical; Communication; Consultations; Cost Savings; Dermatologist; Dermatology; Dimensions; Disease; Disease model; Eczema; European; Evaluation; Fostering; Goals; Health; Health Care Costs; Health Services Accessibility; Improve Access; Individual; Inflammation; Inflammatory; Intelligence; Location; Measures; Mental Depression; Modeling; Morbidity - disease rate; Office Visits; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Persons; Provider; Pruritus; Quality of life; Randomized; Recommendation; Recording of previous events; Relapse; Research; Rural Community; Service delivery model; Severities; Severity of illness; Skin; Sleep Deprivation; Specialist; Structure; Technology; Testing; Transportation; Uncertainty; United States; Visit; Wait Time; base; care delivery; care providers; care seeking; chronic inflammatory skin; clinical imaging; connected health; cost; design; differences in access; follow-up; foster care; health care delivery; health related quality of life; improved; improved outcome; indexing; innovation; instrument; medical specialties; online care; patient oriented; preference; psychosocial; skin disorder; underserved community

PROJECT SUMMARY / ABSTRACT Skin diseases account for 30% of all physician office visits. In the United States, access to dermatologists remains a significant challenge for those in underserved or rural communities. To increase access to specialists and improve patient outcomes, we will evaluate a team-based connected health (TCH) model that enables structured asynchronous online interactions among patients, primary care providers (PCPs), and dermatologists. The goal of TCH is to enable effective management of chronic skin diseases via high-quality and efficient online care between providers and patients. TCH purports to bring direct and expedient specialist care to patients and PCPs in a location-independent and asynchronous manner. Specifically, TCH offers several ways that patients and providers can communicate online asynchronously to manage skin diseases: (1) PCP-dermatologist, (2) patient-dermatologist, and (3) patient-PCP interactions. With PCP-dermatologist interactions, PCPs can access dermatologists online asynchronously for consultations or to request a dermatologist to assume care of patient’s skin disease. With patient-dermatologist interactions, patients can upload clinical images and history online and obtain asynchronous evaluation and recommendations from dermatologists directly. Finally, PCPs have the option of managing their patients’ skin diseases online. Importantly, TCH applies efficient workflow that maximally supports providers and fosters multi-directional, informed communication among patients, PCPs, and dermatologists. To evaluate the impact of TCH, we use atopic dermatitis (AD) as a disease model. AD is a common, relapsing inflammatory skin disease affecting 32 million individuals in the U.S. AD is characterized by intense itching and red, scaly patches. It incurs significant morbidities and high healthcare costs. To address skin inflammation, itch, and psychosocial consequences, PCPs and dermatologists need to adopt a team-based approach to effectively manage all aspects of AD. The primary goal of the proposed research is to test whether the online TCH model results in equivalent improvements in disease severity and quality of life, provides better access to specialist care, and is cost- saving as compared to usual in-person care in pediatric and adult patients with AD. Specifically, we will conduct a pragmatic, cluster-randomized controlled equivalency trial and use validated measures to compare AD disease severity, health-related quality of life, and access to care between TCH and in-person care. We will also compare costs of the two healthcare delivery models from a societal perspective by conducting cost- minimization and sensitivity analyses. This proposal evaluates a significant innovation in specialty-care delivery that will likely result in improved patient outcomes, greater access to specialists, and cost savings. The study findings will be highly impactful and have immense dissemination potential to the management of many other chronic diseases.

项目概要/摘要 在美国，皮肤科医生就诊的病例中，皮肤病占 30%。 对于那些服务不足或农村社区的人来说，增加获得服务的机会仍然是一个重大挑战。 专家并改善患者治疗结果，我们将评估基于团队的互联健康 (TCH) 模型，该模型 实现患者、初级保健提供者 (PCP) 和患者之间的结构化异步在线交互 TCH 的目标是通过高质量的治疗来有效管理慢性皮肤病。 TCH 旨在为提供者和患者提供直接、便捷的在线护理。 以与位置无关的异步方式为患者和 PCP 提供护理。 具体来说，TCH 提供了多种方式，使患者和提供者可以异步在线交流 管理皮肤病：(1) PCP-皮肤科医生，(2) 患者-皮肤科医生，以及 (3) 患者-PCP 互动。 PCP 与皮肤科医生互动，PCP 可以异步在线访问皮肤科医生进行咨询或咨询 要求皮肤科医生负责治疗患者的皮肤病，通过患者与皮肤科医生的互动， 患者可以在线上传临床图像和病史并获得异步评估和 最后，PCP 可以直接根据皮肤科医生的建议来管理患者的皮肤。 重要的是，TCH 采用高效的工作流程，最大限度地支持提供者和培育。 患者、PCP 和皮肤科医生之间的多向、知情沟通。 为了评估 TCH 的影响，我们使用特应性皮炎 (AD) 作为一种常见的复发性疾病模型。 炎症性皮肤病在美国影响着 3200 万人。其特点是剧烈瘙痒和 红色、鳞状斑块会导致严重的发病率和高昂的医疗费用。 瘙痒和社会心理后果，PCP 和皮肤科医生需要采取基于团队的方法来解决 有效管理 AD 的各个方面。 本研究的主要目标是测试在线 TCH 模型的结果是否等效 改善疾病严重程度和生活质量，提供更好的专科护理机会，并且成本低廉 与儿科和成人 AD 患者的常规面对面护理相比，可以节省具体费用。 进行务实的整群随机对照等效试验，并使用经过验证的措施进行比较 AD 疾病的严重程度、与健康相关的生活质量以及在 TCH 和面对面护理之间获得护理的机会。 还通过进行成本评估，从社会角度比较两种医疗保健提供模式的成本 该提案评估了专业护理服务方面的重大创新。 这可能会改善患者的治疗效果、更多地接触专家并节省成本。 研究结果将产生巨大影响，并对许多其他管理人员具有巨大的传播潜力 慢性疾病。