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

项目摘要/摘要 皮肤病占所有医生就诊的30%。在美国，可以去看皮肤科医生 对于那些服务不足或农村社区的人来说，这仍然是一个巨大的挑战。增加访问权限 我们将评估基于团队的互联健康(TCH)模型，该模型 在患者、初级保健提供者(PCP)和 皮肤科医生。TCH的目标是通过高质量的 以及提供者和患者之间高效的在线护理。TCH声称将带来直接和便捷的专家 以独立于位置和异步的方式护理患者和儿科医生。 具体地说，TCH提供了几种患者和提供者可以在线异步交流的方式 管理皮肤病：(1)PCP-皮肤科医生，(2)患者-皮肤科医生，(3)患者-PCP互动。使用 PCP与皮肤科医生的交互，PCP可以异步在线访问皮肤科医生进行会诊或 请求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历，并获得异步评估和 直接来自皮肤科医生的建议。最后，全科医生可以选择管理病人的皮肤 疾病在线。重要的是，TCH应用高效的工作流程，最大限度地支持提供者和养育者 在患者、初级保健医生和皮肤科医生之间进行多方向、知情的交流。 为了评估TCH的影响，我们使用特应性皮炎(AD)作为疾病模型。广告是一种常见的、反复发作的 炎症性皮肤病在美国影响着3200万人。AD的特征是强烈的瘙痒和 红色的鳞片。它会招致严重的疾病和高昂的医疗成本。为了解决皮肤发炎问题， 瘙痒和心理社会后果，初级保健医生和皮肤科医生需要采用基于团队的方法来 有效管理AD的方方面面。 建议的研究的主要目标是测试在线TCH模型是否产生相同的结果 疾病严重程度和生活质量的改善，提供了更好的专科护理机会，而且成本- 与通常的儿童和成人AD患者的面对面护理相比，节省了成本。具体来说，我们将 进行务实、整群随机对照的等效性试验，并使用经过验证的措施进行比较 AD疾病严重程度、与健康相关的生活质量，以及在TCH和面对面护理之间获得护理的机会。我们会 还从社会的角度比较了两种医疗保健提供模式的成本，通过进行成本- 最小化和灵敏度分析。该提案评估了提供特殊护理服务方面的重大创新。 这可能会改善患者的预后，更容易获得专家的帮助，并节省成本。这项研究 调查结果将产生极大的影响，并对许多其他公司的管理具有巨大的传播潜力 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.