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

项目摘要/摘要 皮肤病占所有医生办公室访问的30%。在美国， 对于服务不足或农村社区的人来说，这仍然是一个重大挑战。以方便获得 专家和改善病人的结果，我们将评估一个基于团队的连接健康（TCH）模型， 实现患者、初级保健提供者（PCP）之间的结构化异步在线交互， 皮肤科医生TCH的目标是通过高质量的治疗， 提供者和患者之间的高效在线护理。TCH声称将直接和权宜的专家 以位置无关和异步的方式为患者和PCP提供护理。 具体来说，TCH提供了几种方式，患者和提供者可以在线异步通信， 管理皮肤病：（1）PCP-皮肤科医生，（2）患者-皮肤科医生，（3）患者-PCP相互作用。与 PCP与皮肤科医生的互动，PCP可以在线异步访问皮肤科医生进行咨询， 请皮肤科医生来照顾病人的皮肤病。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， 皮肤科医生的建议。最后，PCP可以选择管理患者的皮肤 疾病在线重要的是，TCH采用高效的工作流程，最大限度地支持供应商和培养 患者、PCP和皮肤科医生之间的多方向、知情的沟通。 为了评估TCH的影响，我们使用特应性皮炎（AD）作为疾病模型。AD是一种常见的复发性 炎症性皮肤病影响美国3200万人AD的特征是剧烈瘙痒， 红色的鳞状斑块它会导致严重的发病率和高昂的医疗费用。为了解决皮肤炎症， 瘙痒和心理社会后果，PCP和皮肤科医生需要采取基于团队的方法， 有效管理AD的各个方面。 所提出的研究的主要目标是测试在线TCH模型是否产生等效的 改善疾病的严重程度和生活质量，提供更好的专科护理，并且成本- 与儿童和成人AD患者的常规亲自护理相比，具体来说，我们将 进行一项实用的、随机分组对照的等效性试验，并使用经验证的指标进行比较 AD疾病严重程度、健康相关生活质量以及TCH和面对面护理之间的护理获得情况。我们将 还从社会角度比较了两种医疗保健提供模式的成本， 最小化和敏感性分析。该提案评估了特殊护理服务方面的一项重大创新 这可能会改善患者的治疗效果，更容易接触到专家，并节省成本。研究 调查结果将具有很大的影响力，并具有巨大的传播潜力，以管理许多其他 慢性病

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.