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

描述(由申请人提供)：长期研究目标是改善患者获得专家护理的机会。近期的研究目标是设计和评估为慢性皮肤病患者提供专科护理的技术使能模式。这些目标与AHRQ的总体使命相关，因为它们旨在评估这些技术支持的模式的质量、效率和有效性，以改善所有美国人，特别是农村和医疗服务不足社区的专科医生的机会。这项研究建议是基于这样一个发现，即获得及时、高质量的皮肤病护理对美国医疗保健系统构成了重大挑战。因此，许多慢性皮肤病患者得不到或得不到改善其整体健康和生活质量所需的皮肤科护理。在这项研究中，阿普丽尔·阿姆斯特朗博士提出了一种新颖的在线模式，为特应性皮炎患者提供直接的后续护理。特应性皮炎是一种慢性皮肤病，数百万美国人患有这种疾病。在这个在线模式中，患者直接与皮肤科医生交流，捕捉和传输数字皮肤图像，并在线接收皮肤科医生的治疗建议和处方。这种在线模式可以改善患者获得及时医疗的机会，并节省患者远离学校或工作的时间。为了评估这种在线模式的有效性，阿姆斯特朗博士设计了一项随机对照试验，将这种新颖的在线模式与传统的办公室访问模式的临床、生活质量和满意度结果进行比较。特应性皮炎的儿童和成人患者将被随机分配到在线组或办公室组进行后续处理。所有受试者都将根据他们的临床改善情况、生活质量的变化、患者满意度以及患者对其疾病的了解情况进行评估。使用卫生信息技术提供以患者为中心的护理引入了一种新的模式，以改善获得专家的机会。阿姆斯特朗博士和她的导师希望证明，患者将是负责任的、愿意的和积极参与这一由通信技术实现的护理交付系统的。这项研究还有望表明，以患者为导向的在线护理是一种在后续临床环境中管理皮肤病的实用和有效的机制。因此，本申请中提出的研究具有重要意义，因为它有望改善皮肤病患者的临床结果，提高生活质量，并增加患者满意度和他们对皮肤病的了解。这种模式有可能适用于患有其他类型慢性疾病的患者，需要定期向专家进行后续访问。这项研究建议与AHRQ的使命产生了共鸣，即使用健康信息技术支持以患者为中心的护理，以管理他们的健康和疾病。 公共卫生相关性：研究以患者为中心的在线模式提供后续专家护理的有效性的拟议研究在几个重要方面与公共卫生相关。这种在线模式将使患者能够积极参与他们的医疗保健，使他们能够直接监测、记录并与他们的专家交流他们的临床进展。居住在偏远地区的患者将更容易获得专家的后续护理，并节省与办公室就诊相关的宝贵时间和成本。此外，将这种在线模式纳入现有的面对面实践可能有助于缩短新患者和要求紧急就诊的患者的等待时间。这项研究将在临床结果、生活质量测量和患者满意度方面得出重要的发现，与传统的面对面访问的“黄金标准”相比，这种在线模式。如果提供后续专家护理的在线模式被证明是有效的，这种以患者为中心的模式有可能增加患者接触专家的机会，并提高许多美国公共卫生的护理质量。

DESCRIPTION (provided by the applicant): The long-term research goal is to improve patient access to specialist care. The immediate research goals are to design and evaluate technology-enabled models of delivering specialist care to patients with chronic dermatologic diseases. These goals are responsive and relevant to the overall mission of AHRQ because they aim to assess the quality, efficiency, and effectiveness of these technology-enabled models to improve specialist access for all Americans, especially those in rural and medically underserved communities. The research proposal is based on the finding that access to timely, high-quality dermatologic care poses a significant challenge in the U.S. health care system. As a result, many patients with chronic skin diseases lack access to or receive insufficient dermatologic care necessary to improve their overall health and quality of life. In this study, Dr. April Armstrong proposed a novel, online model of delivering direct, follow-up care to patients with atopic dermatitis, a chronic skin disease from which millions of Americans suffer. In this online model, the patients communicate directly with their dermatologists, capture and transmit digital skin images, and receive treatment recommendations and prescriptions from their dermatologists online. This online model could improve patient access to timely medical care and save patients time away from school or work. To evaluate the effectiveness of this online model, Dr. Armstrong designed a randomized controlled trial to compare clinical, quality of life, and satisfaction outcomes of this novel, online model with those of the traditional in-office visits. Pediatric and adult patients with atopic dermatitis will be randomized to either the online group or the in-office group for follow-up management. All subjects will be assessed on their clinical improvement, changes in quality of life, patient satisfaction, and patient knowledge regarding their disease. The use of health information technology to deliver patient-centered care introduces a new model for improving access to specialists. Dr. Armstrong and her mentors expect to demonstrate that patients will be responsible, willing, and active participants in this care delivery system that is enabled by communication technology. This study is also expected to show that patient-directed online care is a practical and effective mechanism to manage skin diseases in follow-up clinical settings. Thus, the research proposed in this application is significant because it is expected to improve clinical outcomes for patients with skin diseases, raise quality of life, and increase patient satisfaction and their knowledge about their skin disease. This model has the potential to be adapted for patients suffering from other types of chronic medical conditions requiring regular follow-up visits to specialists. This research proposal resonates with the AHRQ's mission to use health information technology to support patient-centered care in the management of their health and illness. PUBLIC HEALTH RELEVANCE: The proposed research to study the effectiveness of a patient-centered online model for delivering follow-up specialist care is relevant to public health in several important aspects. This online model will empower patients to be active participants in their health care by enabling them to monitor, document, and communicate their clinical progress with their specialists directly. Patients living in remote areas will have improved access to specialists for follow-up care and save valuable time and costs associated with an office visit. Furthermore, the incorporation of this type of online model into an existing face-to-face practice may help shorten wait times for new patients and patients requesting urgent visits. This research study will yield important findings on clinical outcomes, quality of life measures, and patient satisfaction of this online model compared with the "gold standard" of traditional, face-to-face visits. If the online model for delivering follow-up specialist care is shown to be effective, this patient-centered model has the potential to increase patient access to specialists and improve quality of care for many American's Public Health.