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Br J Dermatol. 2017 Sep;177(3):845-853. doi: 10.1111/bjd.15530. Epub 2017 Jul 9.

Temporal trends in healthcare utilization following primary melanoma diagnosis among Medicare beneficiaries.

Lott JP1, Wang Q2,3, Titus LJ3,4, Onega T3,4,5, Nelson HD6,7,8,9, Weinstock MA10,11,12,13, Elmore JG14, Tosteson ANA2,3,15.

Author information

1
Cornell Scott-Hill Health Center, New Haven, CT, U.S.A.
2
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
3
Norris Cotton Cancer Center, Lebanon, NH, U.S.A.
4
Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
5
Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
6
Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, OR, U.S.A.
7
Department of Medical Informatics, Oregon Health & Science University, Portland, OR, U.S.A.
8
Department of Clinical Epidemiology and Medicine, Oregon Health & Science University, Portland, OR, U.S.A.
9
Providence Cancer Center, Providence Health and Services, Portland, OR, U.S.A.
10
Dermatoepidemiology Unit, US Department of Veterans Affairs Medical Center, Providence, RI, U.S.A.
11
Department of Dermatology, Rhode Island Hospital, Providence, RI, U.S.A.
12
Department of Dermatology, Brown University School of Medicine, Providence, RI, U.S.A.
13
Department of Epidemiology, Brown University School of Medicine, Providence, RI, U.S.A.
14
Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, U.S.A.
15
Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.

Abstract

BACKGROUND:

Little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time.

OBJECTIVES:

To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis.

METHODS:

We conducted a before-and-after multiple time series study of Medicare beneficiaries aged ≥ 66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results Medicare database. Primary exposure was time from primary melanoma diagnosis at 3-6 months and 6-24 months postdiagnosis. Covariates included tumour-, patient- and geographical-level characteristics and healthcare utilization in the 6 months before diagnosis. Poisson regression was used to estimate population-based risk-adjusted utilization rates for skin biopsies, benign skin excisions, internal medicine office visits and dermatology office visits.

RESULTS:

The study population included 56 254 patients with first diagnoses of primary melanoma. Most patients were ≥ 75 years old (56·8%), male (62·1%), and had in situ melanoma (42·4%) or localized invasive melanoma (45·9%). From 2000 to 2009, risk-adjusted skin biopsy rates 24 months postdiagnosis increased from 358·3 to 541·3 per 1000 person-years (P < 0·001), and dermatology visits increased from 989·0 to 1535·6 per 1000 person-years (P < 0·001). Benign excisions and internal medicine visits remained stable. In 2000, risk-adjusted skin biopsy rates 6 months postdiagnosis increased by 208·5 relative to the 6 months before diagnosis (148·7 vs. 357·2) compared with an observed absolute increase of 272·5 (290·9 vs. 563·1) in 2009. Trends in dermatology visits were similar.

CONCLUSIONS:

Utilization of skin biopsies and dermatology office visits following primary melanoma diagnosis has increased substantially over time. These results may inform optimization of care delivery for melanoma within the Medicare population.

PMID:
28369774
DOI:
10.1111/bjd.15530
[Indexed for MEDLINE]

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