Teledermatology mobile apps: Implementation and impact on Veterans' access to dermatology

远程皮肤病学已成为一种有效的选择，以提高患者获得高质量的皮肤 在VA照顾。VA的互联护理办公室为VA远程皮肤病学开发了两个创新的移动的应用程序。 其中一个应用程序VA Telederm简化了当前基于工作站的初级保健和初级保健之间的咨询过程， 提供者，远程皮肤病学成像仪和皮肤科医生，并旨在降低使用门槛 远程皮肤病学在VA初级保健诊所。另一个应用程序，我的Telederm，将允许建立皮肤科， 患者可以远程与VA皮肤科医生进行随访，而不是使用面对面的诊所预约。 该应用程序旨在减少适当的既定患者必须前往皮肤科的距离 并提高随访的可靠性。预计还将为新的和 真正需要亲自去看的病人拟议中的研究将检验这一假设 每个应用程序的成功实施将促进退伍军人获得皮肤科护理。每个 移动的应用程序及其相关的技术和临床支持资源将以阶梯式楔形方式推出 群集随机试验设计，涉及最有可能从其使用中获益的研究中心。拟议 研究将比较已经收到应用程序的网站和尚未收到应用程序的网站的结果。 目标1将通过检查两个应用程序的以下主要结果来明确测试假设：1） 时间访问的措施将通过比较干预组和对照组的所有 皮肤科咨询和预约完成时间; 2）地理访问措施将包括旅行 3）全面获得的措施将反映在护理的总实例中， 皮肤科/远程皮肤科就诊的总数。此外，我的结果措施 Telederm应用程序还将包括关于目标日期的后续及时性，以及未出现率， 以及传统皮肤科诊所的新患者比例。结果还将按以下因素分层： 田园风情目标2将检查影响每个应用程序成功实施和影响的因素。 有效项目复制框架和韦纳的组织实施理论 有效性，我们将在3个早期采用者网站为每个应用程序进行深入的形成性评估，以确定 与应用程序实施相关的组织、领导和最终用户特征。在 此外，我们还将利用国家和远程提供的企业范围的数据，衡量实施情况， 在所有参与网站采用应用程序。在研究期结束时，拟议的研究将产生一个 移动的远程皮肤病学在增强退伍军人获得皮肤病学方面的有效性的新文献 服务，以及产生的因素，导致成功的全面理解移动的 实施远程保健。本文的研究结果对VA开发和实现其他移动的 远程医疗计划，更广泛地说，其他计划进行大规模远程医疗的医疗保健组织 干预措施。

Teledermatology has emerged as an effective option to enhance the access of patients to high quality skin care in VA. VA's Office of Connected Care has developed two innovative mobile apps for VA teledermatology. One app, VA Telederm, streamlines the current workstation-based consultative process between primary care providers, teledermatology imagers and dermatologists, and is intended to lower the threshold for utilizing teledermatology in VA primary care clinics. The other app, My Telederm, will allow established dermatology patients to follow-up with VA dermatologists remotely rather than using in-person, clinic-based appointments. The app is intended to reduce the distances that appropriate established patients must travel to dermatology clinics and to improve the reliability of follow-up. It is also anticipated to free up appointment slots for new and established patients who actually must be seen in-person. The proposed research will test the hypothesis that successful implementation of each app will facilitate access of Veterans to dermatologic care. Each mobile app and its associated technical and clinical support resources will be rolled out in a stepped wedge cluster randomized trial design involving sites that are most likely to benefit from their use. The proposed research will compare outcomes for sites that have received the app to those that have not yet received it. Aim 1 will explicitly test the hypothesis by examining the following primary outcomes for both apps: 1) Measures of temporal access will be assessed by comparing intervention and control groups with respect to all dermatology consult and appointment completion times; 2) Measures of geographic access will include travel distance and rurality; 3) Measures of total access will be reflected in the total instances of care as reflected by the total numbers of dermatology/teledermatology encounters. In addition, outcome measures for the My Telederm app will also include timeliness of follow-up with respect to the target date, and the no-show rate, and the proportion of new patients in conventional dermatology clinics. Results will also be stratified by rurality. Aim 2 will examine the factors that affect successful implementation and impact of each app. Guided by the Replicating Effective Programs framework and Weiner's Organizational Theory of Implementation Effectiveness, we will conduct in-depth formative evaluations at 3 early adopter sites for each app to determine organizational, leadership, and end-user characteristics that correlate with implementation of the apps. In addition, using nationally and remotely available enterprise-wide data, we will measure implementation and adoption of apps at all participating sites. At the end of the study period, the proposed research will result in a novel documentation of mobile teledermatology's effectiveness in enhancing Veterans' access to dermatology services, as well as produce a comprehensive understanding of the factors leading to successful mobile telehealth implementation. The results will be of significance to VA as it develops and implements other mobile telehealth programs, and more generally to other healthcare organizations planning for large-scale telehealth interventions.