Evaluating Teledermatology Outcomes in a Regional Public Hospital Network

Thesis Abstract

Teledermatology has emerged as a strategic response to dermatologic service gaps in regional health systems, yet evidence on its outcomes within publicly funded hospital networks remains dispersed and context-dependent. This study addresses the problem of uneven access to specialist dermatology, diagnostic delays, and patient satisfaction variations in a regional public hospital network characterized by dispersed primary care clinics, a centralized telemedicine hub, and limited in-person consultant availability. The aim is to evaluate teledermatology outcomes across diagnostic accuracy, wait times, treatment timeliness, patient and provider satisfaction, and cost implications to inform scalable, equity-oriented service delivery. Specific objectives include (1) comparing diagnostic concordance between teledermatology consultations and subsequent in-person dermatologist assessments, (2) assessing changes in wait times and referral pathways from primary care to dermatology across the network, (3) evaluating clinical management timeliness and treatment adjustments following teleconsultations, (4) measuring patient satisfaction, perceived access, and communication quality, (5) analyzing provider acceptance and workflow impact on primary care and dermatology teams, and (6) estimating direct and indirect cost implications for the health system. A mixed-methods design combines quantitative and qualitative approaches to capture both objective outcomes and stakeholder experiences. The quantitative component employs a retrospective cohort analysis of teledermatology encounters over 24 months (n ? 6,500 cases) drawn from the regional hub and affiliated clinics, with a matched cohort of traditional face-to-face referrals (n ? 2,500). Diagnostic concordance will be evaluated using Cohen’s kappa and Bland–Altman plots for continuous metrics, while wait-time distributions and treatment initiation delays will be analyzed via descriptive statistics and multilevel mixed-effects regression to account for clustering by clinic and time. Cost implications will be estimated through a micro-costing framework, incorporating direct telemedicine costs, patient travel savings, and system-wide throughput changes. The qualitative component includes semi-structured interviews with 40 clinicians (dermatologists, general practitioners, nursing staff) and 60 patients, complemented by focus groups with 6–8 regional administrators. Thematic analysis, guided by the Technology Acceptance Model (TAM) and the Diffusion of Innovations theory, will identify determinants of adoption, perceived usefulness, ease of use, and organizational barriers and enablers. The study will apply theoretical framing from two named theories the Technology Acceptance Model to interpret clinician and patient acceptance, and the Donabedian framework to structure quality assessment across structure, process, and outcomes. Validity will be ensured through triangulation of data sources, member checking in qualitative components, and sensitivity analyses for missing data. Ethical approvals will be secured from the regional health research ethics committee, with informed consent obtained for interviews and focus groups, and strict data governance to protect patient confidentiality. Expected findings anticipate higher diagnostic concordance between teledermatology and in-person assessments in common inflammatory and pigmented lesion categories, with modestly reduced wait times for specialty input and faster initiation of appropriate therapies. Patient satisfaction is projected to be high for access and communication but variable for perceived diagnostic certainty in complex cases, while clinicians may report improved interprofessional collaboration yet concerns about medicolegal accountability and workload. Cost analysis is expected to show favorable per-case cost savings in high-volume clinics, driven by reduced patient travel and optimized specialty throughput, offset by telemedicine platform maintenance and training expenditures. The study will contribute to knowledge by providing robust, context-specific evidence on the clinical, experiential, and economic outcomes of teledermatology in a publicly funded regional network, addressing gaps related to real-world effectiveness, equity of access, and scalability in resource-constrained environments. Practical implications include guidance for optimizing referral pathways, standardizing image capture and triage protocols, and informing policy on reimbursement and investment in telehealth infrastructure. The overarching conclusion will synthesize how teledermatology, when integrated with primary care, improves timely dermatologic care while maintaining quality, with recommendations emphasizing targeted clinical pathways, ongoing training, data-driven quality monitoring, and equitable access strategies across the regional network.