P7602Investigation of patient waiting and processing time in the dermatologyclinic setting

Sarah Koch, MD, MBA, Wake Forest University Department of Dermatology,Winston-Salem, NC, United States; Amy McMichael, MD, Wake Forest UniversityDepartment of Dermatology, Winston-Salem, NC, United States; Lauren Barnes,Wake Forest University Department of Dermatology, Winston-Salem, NC, UnitedStates

Background: One of the key elements of the patient experience and patientsatisfaction is wait time in the clinic. The majority of the existing literature assessingthe relationship between wait time and patient satisfaction is found within theliterature of nondermatologic specialties. As a shortage of dermatologists leads to anundersupply of dermatologic services, patient in-office wait time is becoming acritical issue in the dermatology clinic setting.

Purpose: The purpose of this study is to investigate and uncover any bottlenecks orother causes of delay in the course of processing patients through an academicdermatology clinic.

Methods: Time points of various steps in the dermatology patient encounter fromcheck-in to time seen by physicianwere recorded for all patient encounters for threemonths. Three weeks of data were randomly selected for analysis.

Results: For the primary outcome, ‘‘check-in to MD,’’ the average wait time was 33.0minutes (range, 1-123), and the independent variables which were found to besignificant included time of day, provider, day of week, and week. The number ofpatients seen per clinic per week was found to have a significant positiverelationship with the ‘‘chart on door to MD’’ wait time (P ¼ .01) and the ‘‘check-into MD’’ wait time (P ¼ .02).

Limitations: This study did not include analysis of arrival time before receptioncheck-in or the time of check-out. In addition, this study did not differentiate newpatients from return patients, which may be a factor that contributes to increasedwait times. Because of limited patient satisfaction data points, this studywas not ableto uncover a relationship between wait times and patient satisfaction.

Conclusions: This data has uncovered bottlenecks which will allow our departmentto provide feedback to providers and to make administrative changes in order toimprove clinic wait time. This method of wait time analysis could be applied to anydermatology practice looking to improve wait time in the clinic setting.

AB82

cial support: None identified.

Commer

P8007Malignant melanoma and Spitz nevus incidence in the pediatricpopulation

Phillip Ecker, MD, Minnesota Dermatology, Plymouth, MN, United States; AmyWeaver, MS, Mayo Clinic Department of Health Sciences Research BiostatisticsDivision, Rochester, MN, United States; Mark Pittelkow, MD, Mayo ClinicDepartment 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 BiostatisticsDivision, Rochester, MN, United States

The Rochester Epidemiology Project, a complex array of medical record data andmedical and surgical indexing systems, provides accurate incidence data for diseasesdiagnosed in Olmsted County, MN and was used to calculate incidence data forpediatric melanoma and Spitz nevus. This database includes records from MayoClinic, Olmsted Medical Group, Olmsted Community Hospital, regional hospitals,nursing homes and private practitioners. All cases of melanoma and Spitz nevus inpersons under 18 years of age were identified from 1950-2004 through theRochester Epidemiology Project database. A chart review of [228 charts wasperformed to identify clinical characteristics and diagnoses. Review of pathologywas performed by a single dermatopathologist to confirm diagnoses and furtherdelineate pathologic characteristics. Cases found to be inconsistent with melanomaor Spitz nevus were excluded from the study. Variables considered includeddiagnosis, 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 tumorwere 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 ofSpitz nevus increased significantly from 1990 to 2004 while the incidence ofmelanoma remained stable throughout the studied time frame.

cial support: None identified.

Commer

J AM ACAD DERMATOL

P8178Most common dermatologic diagnoses by age in the United Statesambulatory 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, UnitedStates; Scott Davis, Wake Forest School of Medicine, Winston-Salem, NC, UnitedStates; Steven Feldman, MD, PhD, Wake Forest School of Medicine, Winston-Salem, NC, United States

Background: While skin diseases vary in patients of different ages, little data existabout the relative prevalence of dermatologic conditions by age.

Objective: To determine the most common skin conditions in different age groupsseen by dermatologists in the United States.

Methods: The National Ambulatory Medical Care Survey (NAMCS) was queried fortop diagnoses at dermatologist visits from 1993-2010.

Results: There were 588 million estimated visits to dermatologists in the US from1993-2010. In order of frequency, atopic dermatitis, contact dermatitis, andmolluscum 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 neoplasmof skin, and contact dermatitis for age 25-44; actinic keratosis, benign neoplasm ofskin, and contact dermatitis for age 45-54; actinic keratosis, seborrheic keratosis, andcontact dermatitis for age 55-64; actinic keratosis, nonmelanoma skin cancer, andseborrheic keratosis among those age 65 and older. Contact dermatitis and benignneoplasm were among top 10 most common diagnoses in all groups.

Limitations: While the NAMCS is based on a sample of outpatient visits in the UnitedStates, it cannot directly measure prevalence.

Conclusions: Dermatologic conditions seen in different age groups vary. Whiledermatitis is a common condition in all age groups and skin cancer in the olderpatients, benign neoplasms of the skin are very common among young and elderlypatients.

r for Dermatology Research is supported by an unrestricted edum Galderma Laboratories, L.P.

The Cente cationalgrant fro

P7790Patient-Reported Outcomes of Electrodesiccation & Curettage fortreatment 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, SanFrancisco, CA, United States; Mary-Margaret Chren, MD, University of CaliforniaSan Francisco, San Francisco, CA, United States; Rupa Parvataneni, MS, Universityof California San Francisco, San Francisco, CA, United States; Sarah E. Stuart,University of California San Francisco, San Francisco, CA, United States; SungatGrewal, The Commonwealth Medical College, Scranton, PA, United States

Background: The 5-year recurrence rate of nonmelanoma skin cancer (NMSC) afterelectrodesiccation and curettage (ED&C) is low (\5%), but patient skin-relatedquality of life does not improve after ED&C as it does after excision and Mohsmicrographic surgery. Little is known about other patient-reported outcomes(PROs) of ED&C for NMSC. We compared a variety of PROs following ED&C tothose following excision and Mohs micrographic surgery.

Methods: We selected 717 patients who completed PRO surveys from a prospectivecohort of 1536 patients diagnosed with NMSC from 1999-2000. We measuredjudgment of cosmetic appearance, bother from appearance, bother from scar,treatment worth, and overall treatment satisfaction after 1 year using global itemswith 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 satisfactionafter 3 months. We used the chi-squared test to compare groups for categoricalvariables and the Wilcoxon rank sum test for continuous variables. We usedmultivariable logistic regression models to determine if treatment predicted betteror worse PROs after dichotomizing PROs at themedian and adjusting for age, gender,number of NMSCs at presentation, tumor size, tumor location, basal cell versussquamous cell carcinomas, invasive versus superficial histopathology, practicelocation, and training level of the treating clinician.

Results: The response rate for PROs varied from 66% to 87%. ED&C patients judgedthe posttreatment appearance as worse than those treated with excision or Mohsmicrographic surgery (3.4 6 1.2 vs. 3.7 6 1.1; P ¼ .003).This finding remained inadjusted analyses: patients treated with ED&C were 2.3 times more likely to reportworse appearance (P ¼ .02). Patients treated with ED&C were no more likely,however, to be bothered by the appearance after treatment, and in adjustedanalyses, treatment was not an independent predictor of bother from scar, treatmentworth, or overall treatment satisfaction (all P values ¼ .22). Similarly, treatment wasunrelated to general satisfaction, technical quality, interpersonal manner, commu-nication, financial aspects, time spent with the physician, and accessibility andconvenience (all P values ¼ .25).

Conclusions: ED&C patients judged posttreatment appearance as worse thanexcision and Mohs micrographic surgery patients, but bother with appearancewas similar among treatments, as were other PROs. These data inform cliniciansabout what to expect after treatment of NMSC with ED&C.

cial support: None identified.

Commer

MAY 2014