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BACKGROUND/RATIONALE:
Background/Rationale - For the majority of ambulatory skin conditions encountered in Primary Care and Dermatology Clinics the impact those conditions have on patients' quality of life is of principal importance. Commonly encountered skin diseases frequently result in discomfort or pain, pruritis, emotional concerns, embarrassment, anxiety, and interfere with activities of daily living, work activities, or interpersonal relations. To date, no data exist that compares quality of life outcomes - the fundamental metric to asses in an ambulatory dermatology population - between patients undergoing store and forward teledermatology consultations with patients managed by the conventional consult processes. Existing data does indicate that teledermatology is a reliable and accurate method of diagnosing skin disease.
OBJECTIVE(S):
Objectives - The purpose of this study is to compare store and forward teledermatology with a conventional clinic-based dermatology consultation process. Our primary objective is to determine whether the mean change in patient quality of life, as rated by the overall score and subscale scores of a skin-specific quality of life index (Skindex-16 ), differs between the time of randomization and 9 months for patients evaluated by store and forward teledermatology compared to conventional consult methods. Secondary objectives include (a) assessing time to initial definitive evaluation for subjects using each modality, (2) obtaining preliminary data on clinical course using serial digital imaging, (3) determining whether the change in health care utility differs between patients evaluated by teledermatology and those evaluated by conventional consult methods, and (4) comparing the costs and cost-effectiveness of store and forward teledermatology with conventional consult methods.
METHODS:
Methods - The study is a randomized clinical trial that compares store and forward teledermatology with conventional clinic-based consultations at two "hub" sites (Dermatology Consult Services of the Columbia, MO and Minneapolis, MN VAMCs) and two "spoke" sites (Columbia-affiliated CBOC and the St Cloud, MN VAMC). A total of 456 subjects will be enrolled to test for a mean difference of 10 points in the change score of Skindex 16 using a two sided test and an alpha of 0.05. For the primary outcome measure quality of life, Skindex 16 will be administered at baseline, 3 months, and 9 months. For the secondary outcome of time to initial definitive evaluation, time from randomization to the first definitive evaluation will be measured. Clinical course will be graded on a 5 point scale by an expert panel of three dermatologists. Health care utilities will be measured using time trade-off techniques and the Health Utilities Index Mark 2 (HUI2). We will compare the costs and cost-effectiveness of teledermatology with conventional consult methods by estimating the average cost per patient over the 9 month study period. Costs will be estimated from the VA and societal perspectives.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Impact - Teledermatology has the potential to have a significant impact on veterans' healthcare. There is an unmet demand for Dermatology services distributed throughout a nation-wide patient base. Decentralization of care through the expansion of Community Based Outpatient Centers(CBOCs) adds to the demand for these services. Dermatologic care typically resides only at the largest medical centers within a VISN. Teledermatology is one means of meeting the demand for Dermatology services by delivering dermatologic care to those sites that are geographically removed from the Dermatology Consult Service.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Technology Development and Assessment, Quality of Care, Treatment
Keywords:
Cost effectiveness, Quality assessment, Telemedicine
MeSH Terms:
none
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