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Summary

healthy people welcome
at San Francisco, California and other locations
study started
estimated completion:

Description

Summary

This study will measure the impact of two teledermatology apps, VA Telederm and MY Telederm, WITH TWO SEPARATE TRIALS on access to dermatology care. The overall hypothesis is that sites implementing Department of Veterans Affairs' (VA) teledermatology mobile apps will significantly augment the use of teledermatology and improve Veterans' access to skin care relative to control sites. Specifically, the investigators hypothesize that VA Telederm will facilitate the implementation and adoption of teledermatology among primary care clinic staff, increasing use by existing programs and potentially expanding teledermatology to new sites while reducing patient travel to dermatology clinics. Additionally the investigators hypothesize that My Telederm will improve established patients' ability to follow-up with dermatology care remotely, while opening up dermatology clinic space for other patients.

Official Title

Teledermatology Mobile Apps: Implementation and Impact on Veterans' Access to Dermatology

Details

Access to healthcare is currently a key priority for the Department of Veterans Affairs (VA). The current practice of teledermatology in VA is effective but has not been uniformly implemented, and inefficiencies in the current workstation-based process may discourage teledermatology adoption by primary care clinics. VA Office of Connected Care developed a mobile app, VA Telederm, as a more facile and efficient option that may enhance teledermatology adoption among providers. Once patients establish care in a dermatology clinic, they often need follow-up visits to evaluate responses to treatment and to adjust management, neither of which necessarily requires a face-to-face visit. To address these issues, OCC has additionally developed the My Telederm app to allow established dermatology clinic patients to follow-up in person, the app may improve clinic access to in-person dermatology clinics. The mobile apps are thus new programs that are planned for wide-spread implementation in the VA. The investigators will conduct TWO SEPARATE TRIALS of database reviews to understand how these two apps affect features of dermatology care, specifically related to access to care.

Both apps will be made available over a 2 year period in a randomized, stepped-wedge design to Veterans Health Administration (VHA) facilities. The VA Telederm app will be distributed to 36 eligible VHA facilities that currently have low teledermatology activity and thus have had relatively poor adoption of basic consultative teledermatology. The My Telederm app will be distributed to 24 facilities with dermatology clinics that currently have relatively high teledermatology activity and thus already have relatively mature teledermatology programs ready for advanced operations.

By using health factors and stop codes unique to each app, the investigators will use the VA Corporate Data Warehouse (CDW) to measure the impact of both apps in two separate trials on outcomes reflecting dermatology access. At the end of the study period, the proposed research will result in a novel documentation of mobile teledermatology's effectiveness in enhancing Veteran's access to dermatology service. 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.

Keywords

Introduction of Teledermatology Mobile Apps Teledermatology Telehealth Dermatology Telemedicine Mobile Application

Eligibility

You can join if…

  • For the VA telederm trial, teledermatology at a site constituted a minimum of 0.1% and less than 8.8% of all FY2016 dermatology encounters under secondary stop codes 695/696(teledermatology readings).
  • In total the investigators identified 36 sites eligible for VA Telederm.
  • Conversely, the inclusion criterion for the second trial with My Telederm was that a site had greater than or equal to 8.8% of all FY2016 dermatology encounters under secondary stop codes 695/696.
  • This indicated considerable pre-existing experience with consultative teledermatology and the likely presence of dermatology reader and support personnel needed to implement My Telederm.
  • The investigators identified 24 sites eligible for My Telederm.

You CAN'T join if...

  • VA medical centers with no 695/696 stop code activity in FY2016 or with zero full-time equivalent dermatologists were excluded since these sites likely lack the expertise,support, and infrastructure to feasibly adopt teledermatology during the study period.
  • The investigators also excluded sites outside the continental U.S., sites without a dermatology clinic, and the 3 sites where the formative evaluation of this study will be performed (i.e., Providence, RI; San Francisco, CA; and Denver, CO).

Locations

  • San Francisco VA Medical Center, San Francisco, CA not yet accepting patients
    San Francisco, California, 94121, United States
  • Durham VA Medical Center, Durham, NC in progress, not accepting new patients
    Durham, North Carolina, 27705, United States
  • Providence VA Medical Center, Providence, RI in progress, not accepting new patients
    Providence, Rhode Island, 02908, United States

Details

Status
not yet accepting patients
Start Date
Completion Date
(estimated)
Sponsor
VA Office of Research and Development
ID
NCT03241589
Lead Scientist
Dennis H. Oh
Study Type
Interventional
Last Updated
August 4, 2017
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