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.

皮肤病是不断变化的，随着时间的推移;皮疹耀斑，痣增长，溃疡愈合，慢性皮肤病 严重程度随时间波动。患者只看皮肤科医生在不频繁和不规则的间隔， 与疾病的临床过程相匹配。由于临床医生和研究人员没有简单的监测方法， 在正式临床访问之间的皮肤疾病，关于皮肤疾病进展的有价值的颗粒信息， 目前正在失去对治疗反应的改善。 在美国，65岁以上的老年人越来越多。到2030年， 美国人的年龄将超过65岁，使老年人口与儿科人口的规模相同 人口与此同时，皮肤病的发病率也在上升， 皮肤科医生每年然而，交通困难、行动不便和跌倒风险增加使得频繁就诊 对体弱的老年人具有挑战性的访问。COVID-19疫情加速了 然而，我们对皮肤科医生、老年人和护理人员的定性采访强调， 目前的移动的健康工具存在重大障碍， 回家迫切需要一种用户友好的工具，供老年患者收集照片、症状和 在家监测皮肤病。 我们建议扩大我们的小说，老年人友好，远程皮肤科虚拟助理-皮肤科 老年人（DORA）-支持临床疾病监测。DORA促进皮肤病监测 在家，而不是亲自去诊所。我们的初步数据显示，DORA更容易为老年人 与当前的远程皮肤病学平台相比， 会话文本消息提醒，而不需要高技术素养。 在这项研究中，我们将：1）开发一个纵向图像库的常见皮肤状况影响老年人 包括所有皮肤类型的成人使用DORA。我们将对不同肤色的参与者进行过度抽样， 由皮肤病学图像中颜色皮肤的代表性不足引起的健康护理差异。2)描述 通过观察老年人常见皮肤病的模式和 使用DORA的老年患者的患者经验。我们将比较虚拟收集的信息 在6个月和12个月时通过DORA进行亲自临床评估。3)进行半结构化面试 与来自不同医疗机构的医生一起确定实施和临床的障碍和解决方案， 家庭数字化皮肤病监测的实用性。成功实现这些目标将导致 一种新的、易于使用的方法，可以在家中监测老年人的皮肤疾病， 不必要的门诊，同时保持生活质量。这种方法可以用于其他设置， 技术扫盲障碍和接触皮肤科医生的机会不平等造成了保健差距。