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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:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention Arm | Experimental | Participants in the intervention arm will not receive routine follow-up appointments at the end of their consultation. Instead, their monthly ePROM responses will feed a two-layer Bayesian decision system to determine appointment need. |
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| Control Arm | Active Comparator | Participants in the control arm will continue standard care, with follow-up appointments scheduled at the end of each consultation. The ePROM responses may be used by patients for self-tracking and will be available to clinicians to inform decision-making at subsequent visits. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Flexible ePROM-guided Scheduling System | Behavioral | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of actualised outpatient visits | Difference in actualised outpatient visits (in-person + teleconsult) over 12 months (effectiveness outcome). | baseline to week 52 |
| Proportion of completed monthly ePROMs | Difference in proportion of completed monthly ePROMs (implementation outcome) | baseline to week 52 |
| Measure | Description | Time Frame |
|---|---|---|
| No-show rate | Number of appointments missed without prior rescheduling or cancellation | baseline to week 52 |
| Cancelled or rescheduled appointments | Appointments booked but cancelled or rescheduled before the actual appointment date |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ellie Choi, MBBS | Contact | 65 6908 2222 | dermatology@nuhs.edu.sg |
| Name | Affiliation | Role |
|---|---|---|
| Ellie Choi, MBBS | National University Hospital, Singapore | Principal Investigator |
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IPD shared includes de-identified demographics, disease outcomes and measures.
IPD and supporting information will be available from the time of publication and for four years thereafter.
IPD and supporting information will be available from the study team on a case-by-case basis upon request.
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| electronic patient reported outcome measures (ePROMs) | Behavioral | Monthly electronic patient reported outcome measures (ePROMs) surveys will be sent to patients' mobile devices to capture self-reported disease severity data. |
|
| baseline to week 52 |
| Urgent care or unscheduled visits | Emergency department visits or other urgent care visits related to patient's dermatological condition | baseline to week 52 |
| Skin-specific Quality of Life Impairment | 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). | baseline, 6 months, 12 months |
| Clinician-assessed disease severity | Clinician-assessed disease severity using body surface area and the investigator global assessment on a 0-5 NRS | baseline to week 52 |
| Acceptability of the intervention | Assessed using the Theoretical Framework of Acceptability | week 52 |
| Perceived burden of engaging with the intervention | Research questionnaire assessing perceived burden of intervention use | baseline, 6 months, 12 months |
| Fidelity to the scheduling algorithm | The extent to which algorithm-generated recommendations were followed, overridden, or superseded | baseline to week 52 |
| Barriers and facilitators to implementation | Explored through semi-structured qualitative interviews | week 52 |
| Bayesian Decision-layer outputs | Decision-layer outputs, including monthly posterior summaries and posterior predictive probabilities for each appointment category | baseline to week 52 |
| ID | Term |
|---|---|
| D004485 | Eczema |
| D014581 | Urticaria |
| D011565 | Psoriasis |
| D000152 | Acne Vulgaris |
| ID | Term |
|---|---|
| D003872 | Dermatitis |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D017443 | Skin Diseases, Eczematous |
| D017445 | Skin Diseases, Vascular |
| D006969 | Hypersensitivity, Immediate |
| D006967 | Hypersensitivity |
| D007154 | Immune System Diseases |
| D017444 | Skin Diseases, Papulosquamous |
| D017486 | Acneiform Eruptions |
| D012625 | Sebaceous Gland Diseases |
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