Novel digital tools for home-based monitoring of skin disease

用于家庭皮肤病监测的新型数字工具

• 批准号: 10584139
• 负责人: Eleni Linos
• 金额: $ 17.05万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10584139
• 关键词: Acceleration; Address; Adoption; Affect; Age; American; Biological Markers; COVID-19 pandemic; Caregivers; Caring; Childhood; Chronic; Clinic Visits; Clinical; Clinical Course of Disease; Clinical Research; Clinical assessments; Collection; Data; Dermatologic; Dermatologist; Dermatology; Diagnosis; Disease; Disease Progression; Elderly; Epidemiology; Exanthema; Flare; Frail Elderly; Friends; Future; Geriatrics; Home; Image; Incidence; Inflammatory; Interview; Learning; Longitudinal cohort; Machine Learning; Measures; Modeling; Mole the mammal; Monitor; Natural History; Participant; Patients; Pattern; Persons; Physicians; Pilot Projects; Population; Positioning Attribute; Primary Care; Quality of life; Recommendation; Reporting; Research Personnel; Sampling; Severity of illness; Skin; Structure; Symptoms; Technology; Telemedicine; Text Messaging; Time; Training; Triage; Trust; Ulcer; United States; Visit; Visual; aged; automated text message; design; digital monitoring; digital tool; experience; fall risk; healing; health care disparity; health care settings; human old age (65+); human very old age (85+); image archival system; improved; innovation; intelligent personal assistant; literacy; mHealth; multidisciplinary; novel; older patient; prospective; retention rate; satisfaction; serial imaging; skin color; skin disorder; teledermatology; tool; treatment response; user-friendly; virtual

Skin disease is constantly changing over time; rashes flare, moles grow, ulcers heal, and chronic skin disease severity fluctuates over time. Patients only see dermatologists at infrequent and irregular intervals that do not match the clinical course of the disease. As clinicians and researchers do not have an easy way of monitoring skin disease in between formal clinical visits, valuable granular information about skin disease progression, flares, and improvement in response to treatment, is currently being lost. The number of people in the United States older than 65 years is growing. By 2030, 20% of all Americans will be older than 65 years, making the geriatric population the same size as the pediatric population. The incidence of dermatologic conditions is rising in parallel, with more than 27 million visits to dermatologists each year. Yet transport difficulties, limited mobility and increased fall risks make frequent clinic visits challenging for frail older adults. The COVID-19 pandemic has accelerated the adoption of teledermatology; however, our qualitative interviews with dermatologists, older adults and caregivers highlight substantial barriers with current mobile health tools, with no readily accessible way to monitor skin disease at home. There is an urgent need for a user-friendly tool for older patients to collect photographs, symptoms and monitor their skin disease from home. We propose to expand our novel, older adult-friendly, teledermatology virtual assistant – Dermatology for OldeR Adults (DORA) – to support clinical disease monitoring. DORA facilitates skin disease monitoring from home, instead of in-person clinic visits. Our preliminary data show that DORA is easier for older adults to use compared to current teledermatology platforms because it enables image collection using simple conversational text message reminders, without requiring high technology literacy. In this study we will: 1) Develop a longitudinal image library of common skin conditions affecting older adults including all skin types using DORA. We will oversample participants with skin of color to address healthcare disparities arising from under-representation of skin of color in dermatology images. 2) Describe the progression and natural history of common skin diseases affecting older adults by observing patterns and patient experiences of older patients who use DORA. We will compare the information collected virtually through DORA to in person clinical assessments at 6 and 12 months. 3) Conduct semi-structured interviews with physicians from diverse healthcare settings to identify barriers and solutions to implementation and clinical utility of home-based digital monitoring of skin disease. Successful completion of these aims will result in a novel, readily accessible way to monitor skin disease in older adults from home, reducing burdensome or unnecessary clinic visits while maintaining quality of life. This approach can be used in other settings where technology literacy barriers and unequal access to dermatologists contribute to healthcare disparities.

皮肤病随着时间的推移而不断变化；皮疹发作、痣生长、溃疡愈合和慢性皮肤病； 病情的严重程度会随着时间的推移而波动。患者只会偶尔且不规律地去看皮肤科医生。 与疾病的临床病程相匹配，因为人群和研究人员没有简单的监测方法。 正式临床就诊之间的皮肤病，有关皮肤病进展的宝贵详细信息， 目前，耀斑和对治疗反应的改善正在消失。 到 2030 年，美国 65 岁以上的人口数量将增加，占总人口的 20%。 美国人的年龄将超过 65 岁，使得老年人口与儿科人口规模相同 皮肤病的发病率也在同步上升，就诊人数超过 2700 万人次。 然而，交通困难、行动不便和跌倒风险增加使得皮肤科医生每年都会频繁就诊。 对于体弱的老年人来说，探访具有挑战性。COVID-19 大流行加速了这种方法的采用。 然而，我们对皮肤科医生、老年人和护理人员的定性访谈强调 当前的移动健康工具存在很大障碍，没有方便的方法来监测皮肤病 迫切需要一种用户友好的工具来帮助老年患者收集照片、症状和信息。 在家监测他们的皮肤病。 我们建议扩展我们新颖的、适合老年人的远程皮肤科虚拟助手——皮肤科 for OldeR Adults (DORA) – 支持临床疾病监测 DORA 促进皮肤病监测。 我们的初步数据显示，DORA 更适合老年人在家中进行，而不是亲自去诊所。 与当前的远程皮肤科平台相比，它可以使用简单的方式收集图像 对话式短信提醒，无需高技术素养。 在本研究中，我们将： 1) 开发影响老年人的常见皮肤状况的纵向图像库 成人，包括使用 DORA 的所有皮肤类型，我们将对具有肤色的参与者进行过度采样，以解决问题。 由于皮肤科图像中不同肤色的代表性不足而导致的医疗保健差异 2) 描述。 通过观察影响老年人的常见皮肤病的模式和自然史 我们将比较虚拟收集的信息。 通过 DORA 在 6 个月和 12 个月时进行现场临床评估 3) 进行半结构化访谈。 与来自不同医疗保健环境的医生一起确定实施和临床的障碍和解决方案 成功完成这些目标将导致皮肤病的家庭数字监测的实用性。 在家中监测老年人皮肤病的新颖且易于使用的方法，减少负担或 在保持生活质量的同时避免不必要的就诊。这种方法可用于其他环境。 技术素养障碍和接触皮肤科医生的机会不平等加剧了医疗保健差距。