Efficacy of Tele-Dermatology Triage on Wait Times and Outcomes

Thesis Abstract

The increasing burden of dermatologic consultations and prolonged wait times in traditional in-person pathways has prompted the expansion of tele-dermatology triage, yet robust empirical evidence on its efficacy for reducing wait times and improving clinical outcomes remains limited. This study investigates the effectiveness of tele-dermatology triage in reducing patient wait times and enhancing diagnostic accuracy, timeliness of treatment initiation, and patient-reported outcomes in a real-world setting. The aims are to (1) quantify changes in wait times from referral to initial assessment and from assessment to treatment initiation; (2) evaluate diagnostic concordance between tele-triage assessments and subsequent in-person consultations; (3) assess timeliness of treatment initiation for common dermatological conditions; (4) examine patient satisfaction, perceived access to care, and clinical outcome trajectories over a six-month follow-up; and (5) identify contextual factors influencing tele-triage performance. A mixed-methods design will be employed, combining a quasi-experimental workflow evaluation with a prospective cohort study. The population comprises all referrals to the dermatology service at a metropolitan tertiary hospital over 12 months, with a sample of 1,200 cases allocated to tele-triage pathways and 1,200 matched historical controls treated through standard pathways. Data collection instruments include standardized referral intake logs, tele-triage decision records, electronic medical records for diagnostic codes and treatment timestamps, patient-reported experience measures (PREMs), and a brief post-visit survey. For the qualitative component, semi-structured interviews with 30 patients and 20 clinicians will explore experiences, perceived barriers, and facilitators of tele-triage. Quantitative analyses will involve descriptive statistics, time-to-event (survival) analyses to compare wait times, and multivariate regression models adjusting for age, sex, comorbidity, and prior dermatologic history to assess the association between triage modality and outcomes. Diagnostic concordance will be evaluated using Cohen’s kappa and percent agreement between tele-triage diagnoses and subsequent in-person diagnoses. Treatment initiation timeliness will be assessed with Cox proportional hazards models, and patient-reported outcomes will be analyzed via repeated-measures ANOVA to detect changes over follow-up periods. The theoretical framing will draw on the Technology Acceptance Model and Donabedian’s structure-process-outcome framework to interpret uptake, process efficiency, and quality of care. Expected findings include a statistically significant reduction in average wait times from referral to initial assessment from 21 days to 9–12 days (p<0.001) and from assessment to treatment initiation from 14 days to 6–8 days (p<0.001), substantial diagnostic concordance (kappa 0.72–0.80) indicating high reliability of tele-triage, and improved patient satisfaction scores by 12–18 percentage points in PREMs (p<0.01). It is anticipated that tele-triage will expedite access to care for inflammatory and malignant skin conditions while maintaining safety and diagnostic integrity, with qualitative data highlighting streamlined communication, reduced need for in-person visits, and perceived convenience as key benefits. The study contributes to knowledge by providing rigorous, context-specific evidence on the operational and clinical impact of tele-dermatology triage, informing policy on resource allocation, referral algorithms, and quality assurance in dermatology services. Practical implications include scalable triage protocols, standardized tele-visit templates, and targeted training for clinicians in tele-assessment. Limitations include potential residual confounding, reliance on algorithmic triage decisions, and generalizability constrained to similar urban tertiary care settings. Overall, findings will support evidence-based integration of tele-dermatology triage as a mechanism to reduce wait times while sustaining diagnostic accuracy and patient-centered outcomes, with recommendations for implementation, continuous monitoring, and further research into long-term clinical impact and cost-effectiveness.