Patient-Centered Online Care Model for Follow-Up Management of Atopic Dermatitis (California)

Project Final Report (PDF, 273.64 KB) Disclaimer

Patient-Centered Online Care Model for Followup Management of Atopic Dermatitis - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS09-085: Mentored Clinical Scientist Research Career Development Award (K08)
  • Grant Number: 
    K08 HS 018341
  • Project Period: 
    November 2009 – November 2014
  • AHRQ Funding Amount: 
    $713,340
  • PDF Version: 
    (PDF, 312.29 KB)

Summary: Access to timely, high-quality dermatologic care poses a significant challenge in the United States. Store-and-forward teledermatology—defined as the practice of dermatology through digital capturing and storage of clinical images and information, followed by asynchronous review of the clinical information by a dermatologist—presents an opportunity to improve patient satisfaction and access to dermatological specialist care.

This project introduced a patient-centered, technology-enabled model for delivering followup specialty care. Specifically, dermatologists participated in an asynchronous, online model for delivering direct followup dermatology care to patients with atopic dermatitis. Patients communicated directly with their dermatologists, captured and transmitted digital skin images, and received online treatment recommendations and prescriptions. Patients were randomized to either the patient-centered care online model of followup care, or conventional, face-to-face followup care. Data was collected to compare clinical outcomes, quality of life, patient satisfaction, and patient knowledge about his/her skin disease.

In addition to the research project goals, Dr. Armstrong is furthering her long-term career goal of increasing access to specialist care for patients in rural and medically-underserved communities. Funding from this Mentored Clinical Scientist Research Career Development Award allows Dr. Armstrong to advance her skills in health services research through structured coursework and regular seminars, and mentoring with leaders in health services research, dermatology, and telemedicine.

Specific Aims:

  • Assess the effect of this asynchronous online model for delivering direct followup dermatologic care on clinical outcomes in patients with atopic dermatitis. (Ongoing)
  • Evaluate the effect of this asynchronous online model for delivering direct followup dermatologic care on quality of life in patients with atopic dermatitis. (Ongoing)
  • Determine the level of patient satisfaction and patient knowledge about atopic dermatitis in the asynchronous online model for delivering direct followup dermatologic care. (Ongoing)

2012 Activities: Dr. Armstrong’s primary research work during 2012 was the completion of data collection from the randomized controlled trial and the subsequent data quality-assurance activities needed to prepare data for analysis, including ensuring that the data was coded correctly. Patients in both the intervention and the control groups completed multiple self-assessment tools to assess dermatology-specific quality of life for each of their five visits at 8-week intervals. These included the Patient-Oriented Eczema Measure to assess disease severity, and the Dermatology Life Quality Index or Children’s Dermatology Life Quality Index. Analysis will begin once data entry and cleaning of the full data set is complete.

In terms of professional development, Dr. Armstrong has been publishing and presenting her research and interests. In 2012, she authored or co-authored 28 peer-reviewed publications and presented at several conferences including the American Academy of Dermatology annual meeting, the Metabolic and Vascular conference, and the California Dermatologic Society meeting. She was also invited to be a grand rounds speaker at the University of California Los Angeles, University of California San Francisco, the University of Louisville, Stanford University, and the University of Pennsylvania.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Adults, Other Conditions: Atopic Dermatitis, Pediatric*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

* This target population is one of AHRQ’s priority populations.

Patient-Centered Online Care Model for Followup Management - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS09-085: Mentored Clinical Scientist Research Career Development Award (K08)
  • Grant Number: 
    K08 HS 018341
  • Project Period: 
    November 2009 – November 2014
  • AHRQ Funding Amount: 
    $713,340
  • PDF Version: 
    (PDF, 584.89 KB)


Target Population: Adults, Condition Specific: Atopic Dermatitis, Pediatric*

Summary: Access to timely, high-quality dermatologic care poses a significant challenge in the United States. Store-and-forward teledermatology—defined as the practice of dermatology through digital capturing and storage of clinical images and information, followed by asynchronous review of the clinical information by a dermatologist—presents an opportunity to improve patient satisfaction and access to dermatological specialist care.

The project, started in November 2009, introduced a patient-centered, technology-enabled model for delivering followup specialty care. Specifically, dermatologists from the University of California Davis Medical Center participate in an asynchronous, online model for delivering direct followup dermatology care to patients with atopic dermatitis, a chronic skin disease from which millions of Americans suffer. In this online model, patients communicate directly with their dermatologists, capture and transmit digital skin images, and receive online treatment recommendations and prescriptions via RelayHealth software.

The year-long randomized controlled trial (RCT) will compare clinical outcomes, quality of life, patient satisfaction, and knowledge about their skin disease of dermatology patients receiving conventional, face-to-face followup care to patients receiving followup care via the patient-centered care online model. This model has the potential to be adapted for patients suffering from other medical conditions that require regular followup visits to specialists.

In addition to the research project goals, Dr. Armstrong aims to further her long-term career goal of increasing access to specialist care for patients in rural and medically underserved communities. Funding from this Mentored Clinical Scientist Research Career Development Award will allow Dr. Armstrong to advance her skills in health services research through structured coursework and regular seminars and mentoring with leaders in health services research, dermatology, and telemedicine.

Specific Aims:
  • Assess the effect of this asynchronous, online model for delivering direct, followup dermatologic care on clinical outcomes in patients with atopic dermatitis. (Ongoing)
  • Evaluate the effect of this asynchronous, online model for delivering direct, followup dermatologic care on quality of life in patients with atopic dermatitis. (Ongoing)
  • Determine the level of patient satisfaction and patient knowledge about atopic dermatitis in the asynchronous, online model for delivering direct, followup dermatologic care. (Ongoing)

2010 Activities: The main activity in 2010 was the initiation of the RCT. The project achieved its recruitment goal of 150 patients and by mid-December, approximately 30 patients had completed the year-long study, which included five dermatology visits, either online or traditional office visits, conducted at 8-week intervals. Attrition of patients has been low in both arms of the study. Patients in both the intervention and the control groups complete multiple self assessment tools at each visit, including the Patient-Oriented Eczema Measure to assess disease severity and the Dermatology Life Quality Index or Children’s Dermatology Life Quality Index to assess dermatology specific quality of life.

Preliminary Impact and Findings: The RCT is ongoing, thus the project is still in the data collection phase and does not have any findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

*AHRQ Priority Population.

Patient-Centered Online Care Model for Follow-Up Management of Atopic Dermatitis - Final Report

Citation:
Armstrong A. Patient-Centered Online Care Model for Follow-Up Management of Atopic Dermatitis - Final Report. (Prepared by the University of California, Davis under Grant No. K08 HS018341). Rockville, MD: Agency for Healthcare Research and Quality, 2014. (PDF, 273.64 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
Technology: 
Medical Condition: 
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Project Details - Ended

Summary:

In the United States, there is an inadequate supply of dermatologists to meet the demand for dermatologic services, especially in underserved communities. As a result, patients with chronic skin diseases such as atopic dermatitis, who lack access to regular dermatologic care, experience poor clinical outcomes and significant impairment in quality of life. Studies suggest that teledermatology presents an opportunity to improve access to dermatological specialist care. Store-and-forward teledermatology is defined as the practice of dermatology through digital capturing and transmission of clinical images and patient history, followed by asynchronous evaluation of the clinical information by a dermatologist. The diagnostic accuracy and reliability of store-and-forward teledermatology have been studied and found to be relatively comparable to those of face-to-face care. However, few studies have examined its impact on clinical outcomes.

The objective of this study was to compare effectiveness of patient-accessed teledermatology with in-person office visits for followup management of atopic dermatitis. The investigators tested the hypothesis that patients with atopic dermatitis managed through the direct-access online model would have equivalent improvement in their disease severity as those managed in person.

The investigators performed a 1-year, randomized controlled equivalency clinical trial in medically underserved areas, outpatient clinics, and the general community. The participants included children and adults with atopic dermatitis with access to the Internet, a computer, and a digital camera. After an initial in-person visit, patients were randomized 1:1 to direct-access online or usual in-person care for followup management of atopic dermatitis. In the online group, patients captured and transmitted clinical images and history asynchronously to dermatologists online. Dermatologists then evaluated the clinical information, provided recommendations and education, and prescribed medications online asynchronously. In the in-person group, patients visited dermatologists in their offices for routine followup care.

A total of 156 children and adults were randomized to either online or in-person care for followup management of atopic dermatitis. The investigators found that improvements in atopic dermatitis clinical outcomes, as measured by the Patient Oriented Eczema Measure and Investigator Global Assessment, were comparable between the two groups. Thus, this study showed that direct-access online care may represent an innovative model of delivering dermatological services to patients with chronic skin diseases.