Document Detail


Variation in care for nonmelanoma skin cancer in a private practice and a veterans affairs clinic.
MedLine Citation:
PMID:  15377935     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Nonmelanoma skin cancer is the most common malignancy. Multiple therapies prevent recurrence but vary widely in cost. The most common therapies are local destruction, excision, and Mohs surgery (histologically guided tumor removal). Clinical variables that may affect treatment choices can be identified, but little is known about how clinicians choose among therapies. OBJECTIVE: The objective of this study was to learn if variations exist in the treatment of nonmelanoma skin cancer in different practice settings. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: Subjects consisted of consecutive patients with nonmelanoma skin cancer at a university-affiliated private dermatology practice and the dermatology clinic at the nearby affiliated Veterans Affairs (VA) medical center. DATA: We studied data from medical records and patient surveys. RESULTS: Overall, 1777 nonrecurrent nonmelanoma skin cancers were diagnosed in 1375 patients. Compared with the VA site, patients at the private site were younger, more likely to be female, and less likely to be poor, and their tumors were smaller and less likely to be on visible areas of the body. Treatments varied between the 2 sites (P <0.001). The proportions of tumors treated at the private and VA sites, respectively, were 23% and 19% for destruction, 25% and 48% for excision, and 37% and 25% for Mohs surgery. In multiple clinical subgroups, Mohs surgery was more likely to be performed at the private site than at the VA. Moreover, in multivariable models controlling for clinical features that may have affected treatment choice, tumors at the private site were more likely than tumors at the VA to be treated with Mohs surgery (odds ratio, 2.39; 95% confidence interval, 1.54-3.70). CONCLUSIONS: Care for nonmelanoma skin cancer varied at 2 academic practice sites that are near each other and that share some clinician staff. These findings raise questions not only about overuse or underuse of procedures at the 2 sites, but also about systematic differences in patient preferences and/or physician incentives in prepaid and fee-for-service settings.
Authors:
Mary-Margaret Chren; Anju P Sahay; Laura P Sands; Leah Maddock; Karla Lindquist; Daniel Bertenthal; Peter Bacchetti
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Medical care     Volume:  42     ISSN:  0025-7079     ISO Abbreviation:  Med Care     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-09-20     Completed Date:  2004-10-28     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1019-26     Citation Subset:  IM    
Affiliation:
Dermatology Service, Research Enhancement Award Program of the Health Services Research and Development Service, Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA. mmchren@itsa.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Ambulatory Care
Carcinoma, Basal Cell / surgery,  therapy*
Carcinoma, Squamous Cell / surgery,  therapy*
Cohort Studies
Confidence Intervals
Fee-for-Service Plans
Female
Hospitals, Veterans
Humans
Male
Medical Records
Middle Aged
Odds Ratio
Patient Satisfaction
Physician's Practice Patterns
Poverty
Prepaid Health Plans
Private Practice
Prospective Studies
Skin Neoplasms / surgery,  therapy*
United States
Grant Support
ID/Acronym/Agency:
K02 AR 02203-01/AR/NIAMS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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