Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Family Medicine
Dermoscopy, Skin Neoplasms, Biopsy, Data Management
Background MaineHealth is shifting from a volume-based model to value-based care. Dermoscopy, in trained hands, improves dermatologic care by significantly reducing the number of biopsies necessary to detect melanoma. Currently, a multimodal dermoscopy curriculum is being implemented and disseminated across Maine Medical Partners (MMP) and Maine Medical Center (MMC) primary care residency programs. Two critical components of the curriculum are: 1) In-person didactic/interactive workshops teaching the Triage Amalgamated Dermoscopic Algorithm (TADA) and 2) Longitudinal teledermoscopy trainings with project ECHO (Extension for Community Health Outcomes). We partnered with quality improvement and quality analytics to create a skin tumor database to allow tracking of biopsy rates, melanoma thickness, and cost savings to the system, with the hope of the elucidating the impact of primary care dermoscopy training within a large health system.
Aims Our goal is to develop a skin biopsy database prior to and after the dermoscopy training intervention. We aim to track the following: 1) Total number of biopsies, 2) Benign: malignant biopsy ratios, 3) Melanoma stage and thickness at diagnosis.
Methods Data will be extracted from the electronic medical record Epic for the following date range: 11/05/2013 – 11/06/2023. Data collected will be limited to skin biopsies performed by MaineHealth primary care providers.
Results Preliminary data shows that the majority of lesions biopsied by primary care providers are benign lesions, specifically seborrheic keratoses.
Conclusions It is not known how our multimodal dermoscopy curriculum aimed at primary care providers will impact dermoscopy use, skin cancer detection, biopsy rates, and stage of melanoma diagnosis. Next steps include continued data entry and analysis of changes in biopsy ratios/melanoma thickness every 6 months until 2023. Future directions include comparing our data to that of the Centers for Disease Control and Prevention (CDC) longitudinally to determine if dermoscopy training impacts stage of melanoma at diagnosis.
Seiverling, Elizabeth; Stevens, Kathryn; Ayers, Lindsay; Nussinow, Tyler; Boyd, Michael; Dorr, Gregory; and Ahrns, Hadjh, "Impact of Widespread Dermoscopy Training for a Health System: Development of a Biopsy and Skin Tumor Database" (2020). Costas T. Lambrew Research Retreat 2020. 96.