Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement

Pagani, Kyla; Lukac, Danitza; Olbricht, Suzanne M.; Aronson, Mark D.; Benneyan, James C.; Fernández, Leonor; Salant, Talya; Schiff, Gordon D.; Shafiq, Umber; Sternberg, Scot B.; McGee, Jean S.

doi:10.1007/s00403-022-02456-7

Cited by 2 publications

(5 citation statements)

References 6 publications

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“…4 We did not find associations between referral completion and sex, or proxies for socioeconomic status such as income, insurance, or ADI. Our findings coincide with a recent study from Pagani and colleagues, 6 which found no associations between various sociodemographic variables and referral completion. Our negative findings using adjusted models further support these associations.…”

Section: Discussionsupporting

confidence: 92%

“…Multivariable logistic regression models were constructed with referral completion (yes/no) and referral completion in $31 days or #30 days as the primary outcome variables in accordance with previous studies. 1,6 Only patients who completed their referral were included in the "$31 days or #30 days" model. Predictor variables in each model included sex, age, income, insurance status, CCI Score, ADI, referred dermatology clinic, and personal/ family history of skin cancer.…”

Section: Methodsmentioning

confidence: 99%

“…5 To our knowledge, only 1 single-site, nonadjusted study exists that focuses specifically on characteristics that affect time to dermatology referral completion. 6 To address this gap in the literature, we performed a retrospective review of dermatology referrals from primary care providers for evaluation for specified lesion(s) of concern. We investigated and adjusted for factors associated with delays or failure to complete a dermatology referral and the potential impact of delays on surgical outcomes.…”

mentioning

confidence: 99%

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Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study

Lai,

Bao,

McCaffrey

et al. 2023

Dermatol Surg

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BACKGROUND Delays or failure to complete a dermatologic referral may affect health care outcomes. Factors associated with these delays remain understudied. OBJECTIVE This study investigated socioeconomic and demographic factors associated with delays or failure to complete dermatology referrals and potential impact on surgical outcomes. METHODS A retrospective chart review was performed for 400 patients internally referred to an academic dermatology center from 19 primary-care clinics from July 2018 to June 2019. Only patients referred after an in-person primary-care visit in which the provider documented a specific concerning lesion were included. Multivariate analyses were performed to explore variables associated with delays or failure to complete dermatology referrals. RESULTS Patients were more likely to complete their referral if they had a personal history (adjusted odds ratio [aOR] = 7.843, 95% CI 1.383–14.304) or family history (aOR = 11.307, 95% CI 2.344–20.27) of skin cancer. Patients were more likely to delay referral completion past 30 days if they were ages 18 to 34 (aOR = 6.665, 95% CI 1.285–12.044) and less likely to delay referral past 30 days if they had a previous history of skin cancer (aOR = 0.531, 95% CI 0.181–0.882). LIMITATIONS Single institution, retrospective study, limited surgical patients. CONCLUSION Understanding factors associated with delays in dermatology referral completion can help identify at-risk patient populations.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study

Lai,

Bao,

McCaffrey

et al. 2023

Dermatol Surg

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“…The current referral process is frequently followed by delays and errors . Specialty referrals are often handwritten or free-text descriptors that frequently require clinician input to appropriately triage and schedule patients, in which is associated with increased physician administrative burden.…”

Section: Introductionmentioning

confidence: 99%

“…4 The current referral process is frequently followed by delays and errors. 5 Specialty referrals are often handwritten or free-text descriptors that frequently require clinician input to appropriately triage and schedule patients, in which is associated with increased physician administrative burden. In practices without formal triage workflows, patients are often defaulted to the next available appointment, unless specific "red-flag" complaints are identified by front-line staff.…”

mentioning

confidence: 99%

Single-Lesion Skin Cancer Risk Stratification Triage Pathway

Chen,

Gui,

Yao

et al. 2024

JAMA Dermatol

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ImportanceAccess to timely dermatologic care remains a challenge, especially for patients with new skin lesions. Assessing the efficiency of new triage pathways may assist in better resource allocation and shorter time to care.ObjectiveTo evaluate whether a rule-based triage system was associated with better skin cancer risk stratification of patients and reduced wait times.Design, Setting, and ParticipantsThis retrospective quality improvement cohort study of patients referred to Stanford University dermatology clinics was conducted between November 2017 and January 2023. A rules-based triage system based on a priori–determined high-risk lesion characteristics was implemented.ExposuresReferral reasons and risk factors of patients provided by their primary care physicians.Main Outcomes and MeasuresBiopsy results of patients (diagnosis of any skin cancer and melanoma) at their visit or within 6 months after the visit. Regression models were used to assess the association between risk factors at referral and (1) biopsy outcomes and (2) time to first visit, adjusting for sociodemographic factors.ResultsAmong 37 478 patients (mean [SD] age, 54 (18) years; 21 292 women [57%]), the rates of aggregate biopsy, malignant biopsy specimens, and melanoma were comparable across patients seen after (n = 12 302) and before (n = 25 176) the implementation of the new triage pathway. Patients seen through the lesion pathway had a higher risk of having malignant biopsy results (adjusted risk ratio [aRR], 1.6; 95% CI, 1.4-1.9) and melanoma (aRR, 2.0; 95% CI, 1.2-3.2) than those not seen through the pathway. Lesions that were concerning to referring clinicians for skin cancer were associated with an increased risk of skin cancer (all skin cancer: aRR, 2.8; 95% CI, 2.2-3.5; melanoma: aRR, 2.02; 95% CI, 1.1-3.7). Patients in the 3 high-risk lesion groups were seen faster in the new triage pathway (mean reduction, 26 days; 95% CI, 18-34 days).Conclusions and RelevanceIn this study, a new automated, rules-based referral pathway was implemented that expedited care for patients with high-risk skin cancer. This reform may have contributed to improving patient stratification, reducing the time from referral to first encounter, and maintaining accuracy in identifying malignant lesions. The findings highlight the potential to optimize clinical resource allocation by better risk stratification of referred patients.

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Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement

Cited by 2 publications

References 6 publications

Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study

Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study

Single-Lesion Skin Cancer Risk Stratification Triage Pathway

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