Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Jeffrey A. Coto


In 2016 the United States black population stood at over 43 million with a projected increase of 41% by 2060, and the “two or more races” category will increase by 197.8% (Vespa et al., 2020), thus intensifying the need for diagnostic accuracy of skin diseases for these demographics. The American Academy of Dermatology (, 2020) brochures as well as dermatology textbooks underrepresent skin of color (SOC) cutaneous appearance (Louie and Wilkes, 2018), and darker skin tone dermatology education is limited. This underrepresentation leads to misperceptions, misdiagnoses, and poorer outcomes. The purpose of this evidence-based practice project was evaluation of a technological tool implementation aimed at increasing Nurse Practitioner (NP) and Physician Assistant (PA) diagnostic accuracy in SOC dermatology patients in a large Northern Indiana healthcare system. NP/PA downloaded the VisualDx application ( to their smartphone, acquired the textbook reference Atlas for Skin of Color (Jackson-Richards and Pandya, 2014), and were supplied with a Fitzpatrick Skin Type (FST) scale for skin tone reference ( For any SOC patient where a biopsy was performed the NP/PA documented within the chart 1) skin type, 2) use of VisualDx, and 3) recorded their most confident differential first. The information was forwarded to the NP/PA via the HIPAA approved Doc Halo ( application. A post-intervention survey determining satisfaction, ease of use, and perceived interventional tools’ level of bias was also assigned. Statistical analysis was performed via SPSS using Spearman’s Rho, Cronbach’s Alpha, and Chi-square. The proposed outcome of 90% or greater diagnostic accuracy was not achieved (42.9%), resulting in an inverse relationship with participant’s overall satisfaction of the interventional tools.

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.