Objective: Providers’ use of clinical evidence technologies (CETs) improves their diagnosis and treatment decisions. Despite these benefits, few studies have evaluated the impact of CETs on patient outcomes. Investigators evaluated the effect of one CET, VisualDx, on skin problem outcomes in primary care.

Methods: The cluster-randomized controlled pragmatic trial was set in outpatient clinics at an academic medical center in the Northeast. Participants were Primary Care Providers (PCPs) and adult patients seen for skin problems. The intervention was VisualDx as used by PCPs. Outcomes were patient-reported time from index clinic visit to problem resolution, and the number of follow-up visits to any provider for the same problem. PCPs assigned to intervention agreed to use VisualDx as their primary evidence source for skin problems. Control group PCPs agreed not to use VisualDx. Investigators collected outcome data from patients by phone at 30 day intervals. Cox proportional hazards models assessed time to resolution. Wilcoxon-rank sum tests and logistic regression compared return appointments.

Results: Thirty-two PCPs and 433 patients participated. In proportional hazards modelling adjusted for provider clusters, the days from index visit to skin problem resolution were similar in both groups (HR 0.92; CI 0.70, 1.21 P= 0.54). Patient follow-up appointments did not differ significantly between groups (OR 1.26 95% CI 0.94, 1.70 P =0.29).

Conclusion: This pragmatic trial tested the effectiveness of VisualDx on patient reported skin disease outcomes in a generalizable clinical setting. There was no difference in skin problem resolution or number of follow-up visits when PCPs used VisualDx.


TRIAL REGISTRY: ClinicalTrials.gov: NCT02922738

Authors have no conflicts to declare

AUTHOR CONTRIBUTIONS: MB and BL developed the study desgn and methods, MB conducted participant recruitment and data collection, MB and BL analyzed the data, interpreted it, and wrote and approved the final manuscript.

ACKNOWLEDGEMENTS: The authors wish to thank Research Assistants Gary Atwood MLS, Anna Burke, Ayodelle LeBruin MD, Michael Minyetti BS, Kaitlyn Peper BS, Mary Swenson MLS, and Jae Vick MLS for their careful execution of the research protocol for subject identification, enrollment, and data collection.


Evidence-based Medicine, Decision Support Systems, Primary Health Care, Skin Diseases, Patient Reported Outcomes, Pragmatic Clinical Trials

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This work is licensed under a Creative Commons Attribution 4.0 License.

Supplement 1_ Provider Baseline Survey jmla .docx (19 kB)
Provider Baseline survey

Supplement 2_ Patient Interview Data Collection jmla_.docx (25 kB)
Patient Interview Instrument