Acne, Chronic Dermatological Conditions, Eczema, Psoriasis, Urticaria
Conditions
Keywords
dermatology, flexible scheduling, patient initiated follow up, electronic patient-reported outcomes, ePROMs, Bayesian decision support, outpatient care, health services research, randomised controlled trial, implementation science, healthcare utilisation, appointment no-shows, value-based care
Brief summary
The goal of this clinical trial is to evaluate whether an electronic patient-reported outcome measure (ePROM)-guided flexible scheduling system can improve outpatient clinic resource utilisation in patients attending dermatology outpatient clinics for routine follow-up. The main questions it aims to answer are: * Does the intervention reduce the number of actualised outpatient visits over 12 months compared with standard fixed scheduling? * Does the intervention group achieve higher adherence to monthly ePROM monitoring, as measured by the proportion of completed ePROM submissions?
Interventions
BEHAVIORALFlexible ePROM-guided Scheduling System
Monthly ePROM responses will feed a Bayesian decision system to determine appointment need, which will then be used to make recommendations to patients for scheduling of appointments.
BEHAVIORALelectronic patient reported outcome measures (ePROMs)
Monthly electronic patient reported outcome measures (ePROMs) surveys will be sent to patients' mobile devices to capture self-reported disease severity data.
Sponsors
National University Hospital, Singapore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Dermatology outpatients otherwise due for a follow-up appointment within six months. * Ability to independently navigate and complete ePROMs. * Ability to provide informed consent (including parental consent for minors).
Exclusion criteria
* Patients who require fixed or scheduled in-person visits, including those needing skin cancer surveillance, bedside procedures (e.g., liquid nitrogen therapy), surgical interventions, or routine blood tests for immunosuppressive therapy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of actualised outpatient visits | baseline to week 52 | Difference in actualised outpatient visits (in-person + teleconsult) over 12 months (effectiveness outcome). |
| Proportion of completed monthly ePROMs | baseline to week 52 | Difference in proportion of completed monthly ePROMs (implementation outcome) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| No-show rate | baseline to week 52 | Number of appointments missed without prior rescheduling or cancellation |
| Cancelled or rescheduled appointments | baseline to week 52 | Appointments booked but cancelled or rescheduled before the actual appointment date |
| Urgent care or unscheduled visits | baseline to week 52 | Emergency department visits or other urgent care visits related to patient's dermatological condition |
| Skin-specific Quality of Life Impairment | baseline, 6 months, 12 months | Changes in quality of life using the Dermatology Life Quality Index (DLQI). Minimum Score: 0 (no impact on quality of life). Maximum Score: 30 (extremely large impact on quality of life). |
| Clinician-assessed disease severity | baseline to week 52 | Clinician-assessed disease severity using body surface area and the investigator global assessment on a 0-5 NRS |
| Acceptability of the intervention | week 52 | Assessed using the Theoretical Framework of Acceptability |
| Perceived burden of engaging with the intervention | baseline, 6 months, 12 months | Research questionnaire assessing perceived burden of intervention use |
| Fidelity to the scheduling algorithm | baseline to week 52 | The extent to which algorithm-generated recommendations were followed, overridden, or superseded |
| Barriers and facilitators to implementation | week 52 | Explored through semi-structured qualitative interviews |
| Bayesian Decision-layer outputs | baseline to week 52 | Decision-layer outputs, including monthly posterior summaries and posterior predictive probabilities for each appointment category |
Contacts
CONTACTEllie Choi, MBBS
PRINCIPAL_INVESTIGATOREllie Choi, MBBS
National University Hospital, Singapore
Outcome results
None listed