This proposal details a program for training in patient-oriented outcomes research and applying these skills towards a better understanding of patient care in dermatology. The long-term objectives are to apply expertise in outcomes research in various dermatology-related projects that will emerge with the changing face of health care economics and persistent debate on resource allocation. The overall hypothesis is that dermatologists trained in outcomes research will be better equipped to improve patient care in dermatology. The proposed research will test this hypothesis via the following specific aims: 1. Acquire training in quantitative and analytical skills required for clinical patient-oriented outcomes research in dermatology. 2. Apply these skills in outcomes research to enhance patient care using communication technology in dermatology. Communication technology provides a novel means of delivering uniformly high-quality care to patients in the form of telemedicine. A recent survey of dermatology out-patients evaluating knowledge, attitude and practice of communication technology revealed that more than 65% of patient have access to and use the internet from their homes. More than 50% felt comfortable sending their physicians' medical information or images of their skin using communication technology. The next step is to evaluate the economic and practical impact of introducing a tele-dermatology service to enhance patient care. Cost-effectiveness analysis and decision analysis will be performed to determine the feasibility of a tele-dermatology service at our institution. Next, a sequentially controlled clinical trial will be performed evaluating the ability of patients to compose and transmit a tele-dermatology data set, before and after a training session. A randomized control trial will also be performed to evaluate the medical effectiveness of, and costs associated with the use of tele-dermatology. Incorporation of epidemiological surveillance tools into longitudinal medical records will be a new step in understanding disease prevalence and quality of therapeutic interventions. Data generated as part of this proposal will afford a better understanding of strategies to enhance patient care in dermatology.
