Browsing by Subject "Dermatology"
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Item Assessment of Dermatology Clinic Resources at Safety-Net Hospitals: Results from a National Survey(2017-03-24) Malviya, Neeta; Chong, Benjamin F.; Pandya, Amit; Jacobe, HeidiBACKGROUND: The extent of resources available to outpatient dermatology clinics at safety-net hospitals providing care to the underserved is not well characterized. Identification of resource gaps can direct strategies that improve dermatologic care to this population. OBJECTIVE: To determine the state of resources at safety-net dermatology clinics. We hypothesized that staffing and specialty services at safety-net hospital dermatology clinics were suboptimal, and that these clinics have long patient wait-times and high no-show rates. METHODS: A cross-sectional survey was conducted to assess resources at outpatient dermatology clinics in safety-net hospitals affiliated with US dermatology residency programs. Surveys consisting of 42 questions were sent via e-mail to the chiefs of outpatient dermatology clinics at 50 safety-net hospitals. The survey was administered between July and October 2016. RESULTS: 31 (62%) safety-net dermatology clinics participated in the survey. The median wait time for the third next available appointment for a new and follow-up patient was 45 (interquartile range: 30-90) days and 30 (16.5-55) days, respectively. The median no-show rate was 30% (24.5-35). Clinics reported median ratios of 3 providers to 1 nurse (1.75-4), and 2 providers to 1 medical assistant (2-4). 58.1% utilized non-paid dermatology attendings. 93.5% offered dermatopathology and pediatric dermatology services, while 41.9% had on-site Mohs surgery. CONCLUSION: Patients face long wait times and no-show rates are high, with suboptimal provider to support staff ratios. Most clinics had access to dermatology subspecialty care, such as pediatric dermatology, and dermatopathology. Expanding staffing, improving patient no-show rates, and use of teledermatology could improve access to dermatologic care in safety-net hospital systems.Item Evaluating the Effectiveness of a Teledermatology on System Utilization in a Safety-Net Public Health and Hospital System(2020-05-01T05:00:00.000Z) Wu, Lawrence Wen; Dominguez, Arturo R.; Chong, Benjamin F.; Hynan, Linda S.BACKGROUND: Teledermatology is a potentially useful and cost-effective modality for triaging patients in a primary care setting. However, the effect of teledermatology on health system utilization in a safety net hospital system has not been studied. OBJECTIVE: To determine the effect teledermatology on dermatological-problem related healthcare system utilization. Our hypothesis was that teledermatology would be associated with decreased dermatological-problem related healthcare system utilization. METHODS: The design is a retrospective cohort study comparing patients referred by Parkland Community Outpatient Clinics (COPC) primary care providers for dermatology evaluation during Fiscal Year 2016 (October 1st, 2015 and September 30th, 2016): 1) Patients evaluated through SAF teledermatology, 2). Patients from COPCs that did not have teledermatology available to them and were referred for a face-to-face visit. 3.) Patients from the COPCs in cohort 1 that had teledermatology available but were referred for a face-to-face visit instead. Data from 6 months prior to originating encounter and 18 months post originating encounter were measured. Statistical analysis with binary categorical repeated measures for a saturated model analyzed for significant variations in utilization. Health system utilization was measured at primary care clinics, dermatology and other specialty care clinics, urgent care clinic, and Emergency Room visits at Parkland Memorial Hospital. We compared the demographic, diagnostic, and clinical management data of the 3 cohorts. We measured sex, age, race/ethnicity, health care coverage, and diagnostic category for all 3 cohorts. The patients were classified as either having an inflammatory or neoplastic skin condition. The primary outcome was the percentage of patients with at least 1 visit in a 6-month time interval. Secondary outcomes measured were referral treatment capture rate, time to definitive treatment, and teledermatology response time. RESULTS: There were 809 total participants comprising the 3 cohorts, which were 64% female and with a mean age of 50.4 years. Baseline characteristics among groups were similar except for a higher proportion of eczematous conditions in the teledermatology cohort. Over the 24 month study period, total health system utilization, defined as the percentage of patients with at least 1 visit in each 6-month time interval measured over 4 intervals, was significantly greater for patients with inflammatory conditions receiving a face-to-face referral from both teledermatology and non-teledermatology-utilizing clinics compared to patients receiving teledermatology consults. There are no significant differences all combined, dermatology, and PCP clinic utilization between the face-to-face referrals from teledermatology and non-teledermatology-utilizing groups. CONCLUSION: This study provides evidence for the potential effectiveness of teledermatology improving access to care and reducing system utilization for patients with an inflammatory skin condition in a large safety-net public hospital system. There was no significant difference in utilization in patients with a neoplastic condition. Our results suggest additional benefits of utilizing a teledermatology system in a safety net hospital system.Item [News](1979-05-30) Williams, Ann; Harrell, AnnItem [Southwestern News](1996-12-05) Mullen, KrisItem [UT News](1987-08-07) Rutherford, SusanItem [UT News](1986-04-22) Rutherford, Susan