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

远程皮肤病已经成为一种有效的选择，以加强患者获得高质量皮肤的机会 在退伍军人事务部的护理。退伍军人管理局互联护理办公室为退伍军人管理局远程皮肤病开发了两款创新的移动应用程序。 一款名为VA Telederm的应用程序简化了目前基于工作站的初级保健之间的咨询流程 供应商、远程皮肤科成像师和皮肤科医生，旨在降低使用门槛 退伍军人事务部初级保健诊所的远程皮肤病。另一款名为My Telederm的应用程序将允许已有的皮肤科医生 患者可以远程与退伍军人事务部皮肤科医生进行随访，而不是使用面对面的、基于诊所的预约。 这款应用程序旨在缩短合适的已确诊患者前往皮肤科就诊的距离 以提高临床和随访的可靠性。预计它还将腾出预约时间用于新的和 已经确诊的病人，实际上必须亲自去看。这项拟议的研究将检验这一假设 每个APP的成功实施将为退伍军人获得皮肤病护理提供便利。每个人 移动应用程序及其相关的技术和临床支持资源将以阶梯状楔子形式推出 分组随机试验设计，涉及最有可能从其使用中受益的站点。建议数 研究将比较已经收到该应用程序的网站和尚未收到该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检验该假设：1) 通过比较干预组和控制组对所有 皮肤科会诊和预约完成时间；2)地理准入的衡量标准将包括旅行 距离和乡村；3)全面可获得性的衡量标准将反映在护理总实例中，反映如下 皮肤科/远程皮肤科就诊总数。此外，My的结果衡量标准 Telederm应用程序还将包括针对目标日期的跟踪及时性，以及缺勤率， 以及在传统皮肤科诊所的新患者比例。结果还将按以下方式进行分层 乡村气息。目标2将检查影响每个应用程序成功实施和影响的因素。引导式 通过复制有效计划框架和韦纳的组织实施理论 有效性，我们将在每个应用程序的3个早期采用者站点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、领导力和最终用户特征。在……里面 此外，使用国家和远程可获得的企业范围的数据，我们将衡量实施情况和 在所有参与站点采用应用程序。在研究期结束时，拟议的研究将导致 移动远程皮肤科在促进退伍军人获得皮肤科服务方面的有效性的新文献 服务，以及对导致移动通信成功的因素的全面理解 远程医疗实施。这一结果将对退伍军人管理局开发和实施其他移动设备具有重要意义 远程医疗计划，更广泛地说，面向计划大规模远程医疗的其他医疗保健组织 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.