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Zafar H.M.,University of Pennsylvania | Yang J.,American Academy of Dermatology | Armstrong K.,Massachusetts General Hospital | Groeneveld P.,University of Pennsylvania
Academic Radiology | Year: 2015

Rationale and Objectives: To compare differences in Medicare costs 1 year after initial computed tomographic colonography (CTC) or initial optical colonoscopy (OC). Materials and Methods: We performed a retrospective cohort study of asymptomatic Medicare outpatients aged ≥66years who received initial CTC (n=531) or OC (n=17,593) between January 2007 and December 2008; initial OC patients were matched on county of residence and year of screening. Outcomes included differences in total inpatient and outpatient Medicare costs 1 year after initial CTC or OC and differences in outpatient testing of potential findings in the colon, abdomen, pelvis, and lungs. Results: Higher adjusted costs per patient were revealed in the year after initial CTC compared to initial OC for outpatient testing related to potential colonic ($50; 95% confidence interval [CI], $12-$88; P=.010) and extracolonic findings ($64; 95% CI, $23-$106; P=.002). However, there were no differences in adjusted total costs per patient in the year after either modality ($2065; 95% CI, $1672-$5803; P=.28). Similarly, adjusted costs did not differ between cohorts for inpatient ($267; 95% CI, $1017-$1550; P=.68) or outpatient care ($2828; 95% CI, $311-$5966; P=.08). Conclusions: Despite higher adjusted costs of outpatient testing potentially related to colonic and extracolonic findings among asymptomatic elderly patients 1 year after initial CTC compared to OC, we found no differences in adjusted total, inpatient, or outpatient costs between cohorts. Although Medicare does not cover screening CTC, our results suggest that these modalities generate comparable downstream costs to payers. © 2015 AUR. Source

Watson A.J.,Harvard University | Redbord K.,Private Practice | Redbord K.,George Washington University | Taylor J.S.,Cleveland Clinic | And 3 more authors.
Journal of the American Academy of Dermatology | Year: 2013

Background: To date, no study to our knowledge has examined the nature and scope of medical error in dermatology practice. Objective: We sought to collect and categorize physician-reported errors in dermatology practice. Methods: A survey regarding most recent and most serious errors was developed and distributed to dermatologists attending US meetings. A total of 150 responses were received outlining 152 most recent errors and 130 most serious errors. Survey responses, along with classification systems for other specialties, were used to develop a classification system for medical error in dermatology. Results: The respondents' demographics reflected the specialty: 63% were male, 60% were older than 50 years, and 60% were in solo or group private practice. Of the most recent errors reported, 85% happened once a year or less, and 86% did not result in harm to patients. The most common categories of both most recent and most serious errors were related to assessment (41% and 31%, respectively) and interventions (44% and 52%, respectively). Assessment errors were primarily related to investigations, and commonly involved the biopsy pathway. Intervention errors in the most recent and most serious errors were split between those related to medication (54% and 27%) and those related to procedures (46% and 73%). Of note, 5 and 21 wrong-site surgeries were reported in the most recent and most serious errors groups, respectively. Limitations: Our findings are subject to respondent and recall bias and our classification system, although an important first step, is likely incomplete. Conclusion: Our findings highlight several key areas of patient care in need of safety initiatives, namely the biopsy pathway, medication management, and prevention of wrong-site surgery. © 2012 by the American Academy of Dermatology, Inc. Source

Ryan C.,Baylor University | Korman N.J.,University Hospitals Case Medical Center | Gelfand J.M.,University of Pennsylvania | Lim H.W.,Ford Motor Company | And 9 more authors.
Journal of the American Academy of Dermatology | Year: 2014

Over the past 2 decades, considerable progress has been made to further elucidate the complex pathogenesis of psoriasis, facilitating the development of a new armamentarium of more effective, targeted therapies. Despite these important advances, substantial deficits remain in our understanding of psoriasis and its treatment, necessitating further research in many areas. In the sixth section of the American Academy of Dermatology Psoriasis Guidelines of Care, gaps in research and care were identified. We discuss the most important gaps in research that currently exist and make suggestions for studies that should be performed to address these deficits. These encompass both basic science and clinical research studies, including large, prospective epidemiologic studies to determine the true prevalence and natural history of psoriasis; further molecular studies in patients with psoriatic and psoriatic arthritis to understand the function of psoriasis susceptibility genes and to identify novel therapeutic targets; studies to examine the role of environmental factors in the development of psoriasis; further investigation of the relationship between psoriasis and cardiometabolic disease; studies that examine the role of adjunctive therapies such as psychological interventions in appropriate patient groups; and finally, studies to identify biomarkers of disease severity and treatment response to optimize patient therapy. © 2013 by the American Academy of Dermatology, Inc. Source

Agbai O.N.,Ford Motor Company | Sanchez M.,New York University | Hernandez C.,Illinois College | Kundu R.V.,Northwestern University | And 6 more authors.
Journal of the American Academy of Dermatology | Year: 2014

Skin cancer is less prevalent in people of color than in the white population. However, when skin cancer occurs in non-whites, it often presents at a more advanced stage, and thus the prognosis is worse compared with white patients. The increased morbidity and mortality associated with skin cancer in patients of color compared with white patients may be because of the lack of awareness, diagnoses at a more advanced stage, and socioeconomic factors such as access to care barriers. Physician promotion of skin cancer prevention strategies for all patients, regardless of ethnic background and socioeconomic status, can lead to timely diagnosis and treatment. Public education campaigns should be expanded to target communities of color to promote self-skin examination and stress importance of photoprotection, avoidance of tanning bed use, and early skin cancer detection and treatment. These measures should result in reduction or earlier detection of cutaneous malignancies in all communities. Furthermore, promotion of photoprotection practices may reduce other adverse effects of ultraviolet exposure including photoaging and ultraviolet-related disorders of pigmentation. © 2014 by the American Academy of Dermatology, Inc. Source

Resneck Jr. J.S.,University of California at San Francisco | Kostecki J.,American Academy of Dermatology
Archives of Dermatology | Year: 2011

Objective: To evaluate the migration patterns of dermatologists from residency training to eventual clinical practice to assess whether certain programs or regions were more likely to populate their own areas with graduates. Design: Analysis of existing data from the American Academy of Dermatology's membership database. Setting: The United States and Puerto Rico. Participants: Graduates of US dermatology residency programs completing training before 2005 and actively practicing in 2009. Data from 7067 practicing dermatologists were analyzed. Main Outcome Measures: Distance from training to practice site and state locations of training and practice sites. Results: Almost half (43%) of dermatologists practice within 100 miles of their residency training site, although substantial variation was observed in distance (mean, 538 miles; median, 189 miles). More than 70% of graduates from all but 1 New York City program remain within a 100-mile radius, and several California and Florida programs were most likely to retain trainees in state. The Midwest was a net exporter of residents to the West and South. Conclusions: The relationships between residency and eventual practice locations are complex, but certain regions and training programs have distinct graduate migration patterns. To the extent that further expansions in residency positions are undertaken with local supply and demand of dermatology services in mind, these patterns are among many factors that should be considered. ©2011 American Medical Association. All rights reserved. Source

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