Novel digital tools for home-based monitoring of skin disease - Skin disease is constantly changing over time; rashes flare, moles grow, ulcers heal, and chronic skin disease severity fluctuates over time. Patients only see dermatologists at infrequent and irregular intervals that do not match the clinical course of the disease. As clinicians and researchers do not have an easy way of monitoring skin disease in between formal clinical visits, valuable granular information about skin disease progression, flares, and improvement in response to treatment, is currently being lost. The number of people in the United States older than 65 years is growing. By 2030, 20% of all Americans will be older than 65 years, making the geriatric population the same size as the pediatric population. The incidence of dermatologic conditions is rising in parallel, with more than 27 million visits to dermatologists each year. Yet transport difficulties, limited mobility and increased fall risks make frequent clinic visits challenging for frail older adults. The COVID-19 pandemic has accelerated the adoption of teledermatology; however, our qualitative interviews with dermatologists, older adults and caregivers highlight substantial barriers with current mobile health tools, with no readily accessible way to monitor skin disease at home. There is an urgent need for a user-friendly tool for older patients to collect photographs, symptoms and monitor their skin disease from home. We propose to expand our novel, older adult-friendly, teledermatology virtual assistant – Dermatology for OldeR Adults (DORA) – to support clinical disease monitoring. DORA facilitates skin disease monitoring from home, instead of in-person clinic visits. Our preliminary data show that DORA is easier for older adults to use compared to current teledermatology platforms because it enables image collection using simple conversational text message reminders, without requiring high technology literacy. In this study we will: 1) Develop a longitudinal image library of common skin conditions affecting older adults including all skin types using DORA. We will oversample participants with skin of color to address healthcare disparities arising from under-representation of skin of color in dermatology images. 2) Describe the progression and natural history of common skin diseases affecting older adults by observing patterns and patient experiences of older patients who use DORA. We will compare the information collected virtually through DORA to in person clinical assessments at 6 and 12 months. 3) Conduct semi-structured interviews with physicians from diverse healthcare settings to identify barriers and solutions to implementation and clinical utility of home-based digital monitoring of skin disease. Successful completion of these aims will result in a novel, readily accessible way to monitor skin disease in older adults from home, reducing burdensome or unnecessary clinic visits while maintaining quality of life. This approach can be used in other settings where technology literacy barriers and unequal access to dermatologists contribute to healthcare disparities.
