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Malignant melanoma and Spitz nevus incidence in the pediatric population
P7602
P8178
Investigation of patient waiting and processing time in the dermatology clinic setting Sarah Koch, MD, MBA, Wake Forest University Department of Dermatology, Winston-Salem, NC, United States; Amy McMichael, MD, Wake Forest University Department of Dermatology, Winston-Salem, NC, United States; Lauren Barnes, Wake Forest University Department of Dermatology, Winston-Salem, NC, United States Background: One of the key elements of the patient experience and patient satisfaction is wait time in the clinic. The majority of the existing literature assessing the relationship between wait time and patient satisfaction is found within the literature of nondermatologic specialties. As a shortage of dermatologists leads to an undersupply of dermatologic services, patient in-office wait time is becoming a critical issue in the dermatology clinic setting.
Most common dermatologic diagnoses by age in the United States ambulatory dermatologic care Erin Landis, Wake Forest School of Medicine, Winston-Salem, NC, United States; Arash Taheri, MD, Wake Forest School of Medicine, Winston-Salem, NC, United States; Scott Davis, Wake Forest School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest School of Medicine, WinstonSalem, NC, United States Background: While skin diseases vary in patients of different ages, little data exist about the relative prevalence of dermatologic conditions by age. Objective: To determine the most common skin conditions in different age groups seen by dermatologists in the United States.
Purpose: The purpose of this study is to investigate and uncover any bottlenecks or other causes of delay in the course of processing patients through an academic dermatology clinic. Methods: Time points of various steps in the dermatology patient encounter from check-in to time seen by physician were recorded for all patient encounters for three months. Three weeks of data were randomly selected for analysis. Results: For the primary outcome, ‘‘check-in to MD,’’ the average wait time was 33.0 minutes (range, 1-123), and the independent variables which were found to be significant included time of day, provider, day of week, and week. The number of patients seen per clinic per week was found to have a significant positive relationship with the ‘‘chart on door to MD’’ wait time (P ¼ .01) and the ‘‘check-in to MD’’ wait time (P ¼ .02). Limitations: This study did not include analysis of arrival time before reception check-in or the time of check-out. In addition, this study did not differentiate new patients from return patients, which may be a factor that contributes to increased wait times. Because of limited patient satisfaction data points, this study was not able to uncover a relationship between wait times and patient satisfaction. Conclusions: This data has uncovered bottlenecks which will allow our department to provide feedback to providers and to make administrative changes in order to improve clinic wait time. This method of wait time analysis could be applied to any dermatology practice looking to improve wait time in the clinic setting.
Methods: The National Ambulatory Medical Care Survey (NAMCS) was queried for top diagnoses at dermatologist visits from 1993-2010. Results: There were 588 million estimated visits to dermatologists in the US from 1993-2010. In order of frequency, atopic dermatitis, contact dermatitis, and molluscum contagiosum were the most frequent diagnoses for 0-4 year age group; acne, viral warts, and benign neoplasm of skin for age 5-24; acne, benign neoplasm of skin, and contact dermatitis for age 25-44; actinic keratosis, benign neoplasm of skin, and contact dermatitis for age 45-54; actinic keratosis, seborrheic keratosis, and contact dermatitis for age 55-64; actinic keratosis, nonmelanoma skin cancer, and seborrheic keratosis among those age 65 and older. Contact dermatitis and benign neoplasm were among top 10 most common diagnoses in all groups. Limitations: While the NAMCS is based on a sample of outpatient visits in the United States, it cannot directly measure prevalence. Conclusions: Dermatologic conditions seen in different age groups vary. While dermatitis is a common condition in all age groups and skin cancer in the older patients, benign neoplasms of the skin are very common among young and elderly patients. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P.
Commercial support: None identified.
P7790 Patient-Reported Outcomes of Electrodesiccation & Curettage for treatment of Nonmelanoma Skin Cancer Elyse Galles, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States; Eleni Linos, MPH, PhD, University of California San Francisco, San Francisco, CA, United States; Mary-Margaret Chren, MD, University of California San Francisco, San Francisco, CA, United States; Rupa Parvataneni, MS, University of California San Francisco, San Francisco, CA, United States; Sarah E. Stuart, University of California San Francisco, San Francisco, CA, United States; Sungat Grewal, The Commonwealth Medical College, Scranton, PA, United States Background: The 5-year recurrence rate of nonmelanoma skin cancer (NMSC) after electrodesiccation and curettage (ED&C) is low (\5%), but patient skin-related quality of life does not improve after ED&C as it does after excision and Mohs micrographic surgery. Little is known about other patient-reported outcomes (PROs) of ED&C for NMSC. We compared a variety of PROs following ED&C to those following excision and Mohs micrographic surgery.
P8007
Methods: We selected 717 patients who completed PRO surveys from a prospective cohort of 1536 patients diagnosed with NMSC from 1999-2000. We measured judgment of cosmetic appearance, bother from appearance, bother from scar, treatment worth, and overall treatment satisfaction after 1 year using global items with 1-5 or 7 options. We also used the 18-item Patient Satisfaction Questionnaire (PSQ-18) adapted for NMSC treatment to measure domains of patient satisfaction after 3 months. We used the chi-squared test to compare groups for categorical variables and the Wilcoxon rank sum test for continuous variables. We used multivariable logistic regression models to determine if treatment predicted better or worse PROs after dichotomizing PROs at the median and adjusting for age, gender, number of NMSCs at presentation, tumor size, tumor location, basal cell versus squamous cell carcinomas, invasive versus superficial histopathology, practice location, and training level of the treating clinician. Results: The response rate for PROs varied from 66% to 87%. ED&C patients judged the posttreatment appearance as worse than those treated with excision or Mohs micrographic surgery (3.4 6 1.2 vs. 3.7 6 1.1; P ¼ .003).This finding remained in adjusted analyses: patients treated with ED&C were 2.3 times more likely to report worse appearance (P ¼ .02). Patients treated with ED&C were no more likely, however, to be bothered by the appearance after treatment, and in adjusted analyses, treatment was not an independent predictor of bother from scar, treatment worth, or overall treatment satisfaction (all P values ¼ .22). Similarly, treatment was unrelated to general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with the physician, and accessibility and convenience (all P values ¼ .25).
Malignant melanoma and Spitz nevus incidence in the pediatric population Phillip Ecker, MD, Minnesota Dermatology, Plymouth, MN, United States; Amy Weaver, MS, Mayo Clinic Department of Health Sciences Research Biostatistics Division, Rochester, MN, United States; Mark Pittelkow, MD, Mayo Clinic Department of Dermatology, Rochester, MN, United States; Roger Weenig, MD, MPH, Mayo Clinic Department of Dermatology, Rochester, MN, United States; Samuel Ecker, DO, Larkin Community Hospital, South Miami, FL, United States; Xujian Li, MS, Mayo Clinic Department of Health Sciences Research Biostatistics Division, Rochester, MN, United States The Rochester Epidemiology Project, a complex array of medical record data and medical and surgical indexing systems, provides accurate incidence data for diseases diagnosed in Olmsted County, MN and was used to calculate incidence data for pediatric melanoma and Spitz nevus. This database includes records from Mayo Clinic, Olmsted Medical Group, Olmsted Community Hospital, regional hospitals, nursing homes and private practitioners. All cases of melanoma and Spitz nevus in persons under 18 years of age were identified from 1950-2004 through the Rochester Epidemiology Project database. A chart review of [228 charts was performed to identify clinical characteristics and diagnoses. Review of pathology was performed by a single dermatopathologist to confirm diagnoses and further delineate pathologic characteristics. Cases found to be inconsistent with melanoma or Spitz nevus were excluded from the study. Variables considered included diagnosis, age, sex, treatment, recurrence, and follow-up time. During 1950-2004, 7 cases of melanoma, 55 cases of Spitz nevus, and 1 case of atypical Spitzoid tumor were identified. The overall incidence of melanoma was 0.49 per 100,000 persons (95% CI, 0.1-0.9) and of Spitz nevus was 3.63 (95% CI, 2.7-4.6). The incidence of Spitz nevus increased significantly from 1990 to 2004 while the incidence of melanoma remained stable throughout the studied time frame.
Conclusions: ED&C patients judged posttreatment appearance as worse than excision and Mohs micrographic surgery patients, but bother with appearance was similar among treatments, as were other PROs. These data inform clinicians about what to expect after treatment of NMSC with ED&C.
Commercial support: None identified.
Commercial support: None identified.
AB82
J AM ACAD DERMATOL
MAY 2014
P8178
Investigation of patient waiting and processing time in the dermatology clinic setting Sarah Koch, MD, MBA, Wake Forest University Department of Dermatology, Winston-Salem, NC, United States; Amy McMichael, MD, Wake Forest University Department of Dermatology, Winston-Salem, NC, United States; Lauren Barnes, Wake Forest University Department of Dermatology, Winston-Salem, NC, United States Background: One of the key elements of the patient experience and patient satisfaction is wait time in the clinic. The majority of the existing literature assessing the relationship between wait time and patient satisfaction is found within the literature of nondermatologic specialties. As a shortage of dermatologists leads to an undersupply of dermatologic services, patient in-office wait time is becoming a critical issue in the dermatology clinic setting.
Most common dermatologic diagnoses by age in the United States ambulatory dermatologic care Erin Landis, Wake Forest School of Medicine, Winston-Salem, NC, United States; Arash Taheri, MD, Wake Forest School of Medicine, Winston-Salem, NC, United States; Scott Davis, Wake Forest School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest School of Medicine, WinstonSalem, NC, United States Background: While skin diseases vary in patients of different ages, little data exist about the relative prevalence of dermatologic conditions by age. Objective: To determine the most common skin conditions in different age groups seen by dermatologists in the United States.
Purpose: The purpose of this study is to investigate and uncover any bottlenecks or other causes of delay in the course of processing patients through an academic dermatology clinic. Methods: Time points of various steps in the dermatology patient encounter from check-in to time seen by physician were recorded for all patient encounters for three months. Three weeks of data were randomly selected for analysis. Results: For the primary outcome, ‘‘check-in to MD,’’ the average wait time was 33.0 minutes (range, 1-123), and the independent variables which were found to be significant included time of day, provider, day of week, and week. The number of patients seen per clinic per week was found to have a significant positive relationship with the ‘‘chart on door to MD’’ wait time (P ¼ .01) and the ‘‘check-in to MD’’ wait time (P ¼ .02). Limitations: This study did not include analysis of arrival time before reception check-in or the time of check-out. In addition, this study did not differentiate new patients from return patients, which may be a factor that contributes to increased wait times. Because of limited patient satisfaction data points, this study was not able to uncover a relationship between wait times and patient satisfaction. Conclusions: This data has uncovered bottlenecks which will allow our department to provide feedback to providers and to make administrative changes in order to improve clinic wait time. This method of wait time analysis could be applied to any dermatology practice looking to improve wait time in the clinic setting.
Methods: The National Ambulatory Medical Care Survey (NAMCS) was queried for top diagnoses at dermatologist visits from 1993-2010. Results: There were 588 million estimated visits to dermatologists in the US from 1993-2010. In order of frequency, atopic dermatitis, contact dermatitis, and molluscum contagiosum were the most frequent diagnoses for 0-4 year age group; acne, viral warts, and benign neoplasm of skin for age 5-24; acne, benign neoplasm of skin, and contact dermatitis for age 25-44; actinic keratosis, benign neoplasm of skin, and contact dermatitis for age 45-54; actinic keratosis, seborrheic keratosis, and contact dermatitis for age 55-64; actinic keratosis, nonmelanoma skin cancer, and seborrheic keratosis among those age 65 and older. Contact dermatitis and benign neoplasm were among top 10 most common diagnoses in all groups. Limitations: While the NAMCS is based on a sample of outpatient visits in the United States, it cannot directly measure prevalence. Conclusions: Dermatologic conditions seen in different age groups vary. While dermatitis is a common condition in all age groups and skin cancer in the older patients, benign neoplasms of the skin are very common among young and elderly patients. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P.
Commercial support: None identified.
P7790 Patient-Reported Outcomes of Electrodesiccation & Curettage for treatment of Nonmelanoma Skin Cancer Elyse Galles, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States; Eleni Linos, MPH, PhD, University of California San Francisco, San Francisco, CA, United States; Mary-Margaret Chren, MD, University of California San Francisco, San Francisco, CA, United States; Rupa Parvataneni, MS, University of California San Francisco, San Francisco, CA, United States; Sarah E. Stuart, University of California San Francisco, San Francisco, CA, United States; Sungat Grewal, The Commonwealth Medical College, Scranton, PA, United States Background: The 5-year recurrence rate of nonmelanoma skin cancer (NMSC) after electrodesiccation and curettage (ED&C) is low (\5%), but patient skin-related quality of life does not improve after ED&C as it does after excision and Mohs micrographic surgery. Little is known about other patient-reported outcomes (PROs) of ED&C for NMSC. We compared a variety of PROs following ED&C to those following excision and Mohs micrographic surgery.
P8007
Methods: We selected 717 patients who completed PRO surveys from a prospective cohort of 1536 patients diagnosed with NMSC from 1999-2000. We measured judgment of cosmetic appearance, bother from appearance, bother from scar, treatment worth, and overall treatment satisfaction after 1 year using global items with 1-5 or 7 options. We also used the 18-item Patient Satisfaction Questionnaire (PSQ-18) adapted for NMSC treatment to measure domains of patient satisfaction after 3 months. We used the chi-squared test to compare groups for categorical variables and the Wilcoxon rank sum test for continuous variables. We used multivariable logistic regression models to determine if treatment predicted better or worse PROs after dichotomizing PROs at the median and adjusting for age, gender, number of NMSCs at presentation, tumor size, tumor location, basal cell versus squamous cell carcinomas, invasive versus superficial histopathology, practice location, and training level of the treating clinician. Results: The response rate for PROs varied from 66% to 87%. ED&C patients judged the posttreatment appearance as worse than those treated with excision or Mohs micrographic surgery (3.4 6 1.2 vs. 3.7 6 1.1; P ¼ .003).This finding remained in adjusted analyses: patients treated with ED&C were 2.3 times more likely to report worse appearance (P ¼ .02). Patients treated with ED&C were no more likely, however, to be bothered by the appearance after treatment, and in adjusted analyses, treatment was not an independent predictor of bother from scar, treatment worth, or overall treatment satisfaction (all P values ¼ .22). Similarly, treatment was unrelated to general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with the physician, and accessibility and convenience (all P values ¼ .25).
Malignant melanoma and Spitz nevus incidence in the pediatric population Phillip Ecker, MD, Minnesota Dermatology, Plymouth, MN, United States; Amy Weaver, MS, Mayo Clinic Department of Health Sciences Research Biostatistics Division, Rochester, MN, United States; Mark Pittelkow, MD, Mayo Clinic Department of Dermatology, Rochester, MN, United States; Roger Weenig, MD, MPH, Mayo Clinic Department of Dermatology, Rochester, MN, United States; Samuel Ecker, DO, Larkin Community Hospital, South Miami, FL, United States; Xujian Li, MS, Mayo Clinic Department of Health Sciences Research Biostatistics Division, Rochester, MN, United States The Rochester Epidemiology Project, a complex array of medical record data and medical and surgical indexing systems, provides accurate incidence data for diseases diagnosed in Olmsted County, MN and was used to calculate incidence data for pediatric melanoma and Spitz nevus. This database includes records from Mayo Clinic, Olmsted Medical Group, Olmsted Community Hospital, regional hospitals, nursing homes and private practitioners. All cases of melanoma and Spitz nevus in persons under 18 years of age were identified from 1950-2004 through the Rochester Epidemiology Project database. A chart review of [228 charts was performed to identify clinical characteristics and diagnoses. Review of pathology was performed by a single dermatopathologist to confirm diagnoses and further delineate pathologic characteristics. Cases found to be inconsistent with melanoma or Spitz nevus were excluded from the study. Variables considered included diagnosis, age, sex, treatment, recurrence, and follow-up time. During 1950-2004, 7 cases of melanoma, 55 cases of Spitz nevus, and 1 case of atypical Spitzoid tumor were identified. The overall incidence of melanoma was 0.49 per 100,000 persons (95% CI, 0.1-0.9) and of Spitz nevus was 3.63 (95% CI, 2.7-4.6). The incidence of Spitz nevus increased significantly from 1990 to 2004 while the incidence of melanoma remained stable throughout the studied time frame.
Conclusions: ED&C patients judged posttreatment appearance as worse than excision and Mohs micrographic surgery patients, but bother with appearance was similar among treatments, as were other PROs. These data inform clinicians about what to expect after treatment of NMSC with ED&C.
Commercial support: None identified.
Commercial support: None identified.
AB82
J AM ACAD DERMATOL
MAY 2014