ArticleJournal of primary care & community health
Systematic Automated Population-Based Surveillance to Improve Outcomes in Primary Cutaneous Melanoma.
Article in Journal of primary care & community health. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
importancePatients with a primary cutaneous melanoma (PCM) are at increased risk of developing a second primary melanoma (SPM). Earlier stage at diagnosis is associated with better 5-year mortality, yet low compliance with recommended follow-up after treatment for PCM and high rates of patients lost to follow-up are reported in the literature. Strategies to enhance population-based surveillance for SPM have not been well described.
objectiveTo determine whether the implementation of a systematic automated population-based program (SAPP) to ensure dermatologist total body skin exams (TBSEs) in the PCM population compared to the pre-automated period and pre-database periods improves compliance with follow-up, detects more SPMs, or affects mortality?
designQuality Improvement Study.
settingLarge integrated health care system with internalized Dermatology services.
participantsMembers with a PCM prior to, or during the study periods of interest, were included in this quality improvement study. There were 6317 eligible individuals with PCMs in 3 study periods: pre-Database (1/1/2005-11/1/2009), pre-Automation (11/1/09-7/31/15), and post-Automation (8/1/15-12/31/2021), respectively. INTERVENTION(S) OR EXPOSURE(S): Manual registry for melanoma patients (pre-Automation) and systematic automated population-based program for PCM patients (post-Automation). MAIN OUTCOME(S) AND MEASURE(S): Mean number of TBSE per person-year. Time Between TBSE. Incidence of SPM detection. Stage of SPM at diagnosis. Melanoma Death and All-Cause Mortality.
resultsIn patients with PCM, a SAPP to ensure dermatologist TBSE, reduces median time (months) between TBSEs from 12.3 pre-Database to 8.2 post-Automation (stage 0-2a PCM) and from 10.3 to 6.8 (stage 2b-4 PCM;
conclusionImplementing a systematic, automated population-based Melanoma program to ensure dermatologist TBSEs improves compliance with follow-up in patients with PCM. More patients received at least annual dermatologist TBSEs and more SPMs were detected at earlier stages. Improvements were sustained and there were significantly lower all-cause and melanoma-cause mortality. The system facilitates prioritization of higher risk patients for intervention and is a unique strategy enhancing patient safety, efficiency, and timeliness of care.
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