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Dodson JA, Ibrahim SA, Rogers H, Council ML, Nehal KS, Tung R, Leffell DJ, Zeitouni NC, Totonchy MB, Fosko SW, Lee Soon S, Blalock TW, Brodland DG, Billingsley EM, Scott JF, Leach BC, Ratner D, Washington C, Hanke CW, Otley CC, Golda N, Nijhawan RI, Brewer J, Demer A, Fish F, Harmon CB, Zitelli J, Knackstedt T, Singh G, Mollet T, Carr DR, Albertini JG, Moody BR, McDonald M, Bordeaux JS, Massey PR, MacCormack MA, Vidimos A, Arpey CJ, Arron ST, Ibrahimi OA, Jiang SB, Miller CJ, Maher IA, Wysong A, Leshin B, Goldman GD, Kibbi N, Feng H, Collins L. Identifying critical quality metrics in Mohs Surgery: A national expert consensus process. J Am Acad Dermatol 2024; 90:798-805. [PMID: 38081390 DOI: 10.1016/j.jaad.2023.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/16/2023] [Accepted: 10/20/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care. OBJECTIVE The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS. METHODS Mohs surgeons participated in a modified Delphi process to reach a consensus on a list of metrics. Patients were administered surveys to gather patient perspectives. RESULTS Twenty-four of the original 66 metrics met final inclusion criteria. Broad support for the initiative was obtained through physician feedback. LIMITATIONS Limitations of this study include attrition bias across survey rounds and participation at the consensus meeting. Furthermore, the list of metrics is based on expert consensus instead of quality evidence-based outcomes. CONCLUSION With the goal of identifying metrics that demonstrate excellence in performance of MMS, this initial effort has shown that Mohs surgeons and patients have unique perspectives and can be engaged in a data-driven approach to help define excellence in the field of MMS.
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Affiliation(s)
- Joseph A Dodson
- Rush Medical College of Rush University Medical Center, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Howard Rogers
- President, American College of Mohs Surgery, CMO, Advanced Dermatology, Norwich, Connecticut
| | - M Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca Tung
- Florida Dermatology and Skin Cancer Centers, Winter Haven, Florida
| | - David J Leffell
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Nathalie C Zeitouni
- Division of Dermatology, Department of Internal Medicine, University of Arizona, Phoenix, Arizona
| | | | - Scott W Fosko
- Department of Dermatology, University of Florida, Gainesville, Florida
| | | | - Travis W Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian C Leach
- The Skin Surgery Center of Charleston, Mount Pleasant, South Carolina
| | - Desiree Ratner
- Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Carl Washington
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Partner; Dermatology Associates of Georgia, Decatur, Georgia
| | - C William Hanke
- Laser and Skin Surgery Center of Indiana, Indianapolis, Indiana; Program Director, ACGME Micrographic Surgery/Dermatologic Oncology Fellowship Training Program, Ascension St. Vincent Hospital, Indianapolis, Indiana; Department of Dermatology, University of Iowa-Carver College of Medicine, Iowa City, Iowa
| | - Clark C Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Golda
- Dermatology and Skin Cancer Centers, Kansas City, Missouri
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jerry Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Frederick Fish
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - John Zitelli
- Department of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas Knackstedt
- Mohs Surgery Unit, Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina; Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Todd Mollet
- Department of Dermatology, Skin Surgery Center of Oklahoma, Oklahoma City, Oklahoma
| | - David R Carr
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Michel McDonald
- Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, Warren Alpert Medical School at Brown University, Worcester, Massachusetts
| | | | | | - Allison Vidimos
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Omar A Ibrahimi
- Department of Dermatology, Connecticut Skin Institute, Stamford, Connecticut
| | | | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Barry Leshin
- Department of Dermatology, Skin Surgery Center, Winston-Salem, North Carolina
| | | | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Lindsey Collins
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Snow GE, Byrne P, Stewart CM, Eisele DW, Wright SM, Akst LM. Clinical Excellence in Otolaryngology-Head and Neck Surgery: Examples from the Published Literature. Laryngoscope 2021; 131:E2153-E2158. [PMID: 33751585 DOI: 10.1002/lary.29511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS To apply the domains of clinical excellence, as published by the Miller-Coulson Academy of Clinical Excellence, to the field of otolaryngology-head and neck surgery (OHNS) as a framework for evaluating and improving clinical excellence. METHODS A search of PubMed, Scopus, the Cochrane Library, and the National Institute for Health and Care Excellence (NICE) databases was performed and 229 publications were reviewed. RESULTS Case reports and other articles were selected that exemplify each of the distinct domains of clinical excellence within our specialty. CONCLUSIONS The Miller-Coulson Academy's domains of clinical excellence are relevant to OHNS and can provide a framework for fostering clinical excellence in otolaryngologists. The many examples of excellent care by otolaryngologists found in the published literature can inspire otolaryngologists to provide outstanding care to all patients consistently and to advance our specialty. LEVEL OF EVIDENCE N/A Laryngoscope, 131:E2153-E2158, 2021.
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Affiliation(s)
- Grace E Snow
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Patrick Byrne
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Scott M Wright
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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A Cross-Sectional Study on the Affordable Care Act from the Perspective of People Living with HIV: The Interplay between Knowledge, Stigma, Trust, and Attitudes. AIDS Res Treat 2020; 2020:6081721. [PMID: 33376606 PMCID: PMC7744239 DOI: 10.1155/2020/6081721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background Many AIDS Drug Assistance Programs (ADAPs) purchased Affordable Care Act (ACA) Qualified Health Plans (QHPs) for low-income people living with HIV (PLWH). To date, little has been published about PLWH's perspective on the ACA. We explored ACA knowledge, HIV stigma, trust in the healthcare system, and ACA attitudes among PLWH with ADAP-funded QHPs in Virginia. Methods Participants were surveyed about demographic characteristics, ACA knowledge, HIV stigma, trust in various healthcare and government entities, and attitudes toward the ACA. Descriptive statistics were used. We assessed for associations (1) between baseline characteristics and correct ACA knowledge, HIV-related stigma, trust, and ACA attitudes and (2) between correct ACA knowledge and the following data: sources of ACA knowledge, HIV stigma, and trust. Results Participants (n = 53) were a vulnerable population based on the assessment of social determinants of health, and 30% had correct ACA knowledge. Almost three-fourths of participants used HIV clinic case managers for ACA information. Participants who used websites for ACA information had correct ACA knowledge more often compared to those that did not (71% vs. 15%; p = 0.001). Those with correct ACA knowledge had lower stigma scores compared to those without correct ACA knowledge (93.8; SD: 15.4 vs. 108; SD: 20.3; p = 0.01). Participants trusted HIV clinicians more than general clinicians and insurance companies. No association was found between having correct ACA knowledge and endorsing having enough information about the ACA to understand how it will impact their HIV care. Conclusions Websites imparted accurate ACA information. HIV clinic case managers were the most used source, and HIV clinicians were a trusted source of information. HIV clinicians and case managers should consider disseminating information about the ACA and its impact on HIV care delivery via internet videos. Lack of internet and stigma are a threat to PLWH gaining actionable healthcare information.
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McManus KA, Ferey J, Farrell E, Dillingham R. National Survey of US HIV Clinicians: Knowledge and Attitudes About the Affordable Care Act and Opinions of its Impact on Quality of Care and Barriers to Care. Open Forum Infect Dis 2020; 7:ofaa225. [PMID: 32665960 PMCID: PMC7336569 DOI: 10.1093/ofid/ofaa225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background The Affordable Care Act’s (ACA’s) major reforms started in 2014. In addition to assessing HIV clinicians’ ACA knowledge and attitudes, this study aims to evaluate HIV clinicians’ perspectives on whether the ACA has impacted the quality of HIV care and whether it addresses the main barriers to HIV care. Methods HIV clinicians were emailed a survey weblink in 2018. Descriptive statistics, Mann-Whitney U tests, and binary logistic regression were performed. Results Of the 211 survey participants, the majority (70%) answered all 4 knowledge questions correctly. About 80% knew correctly whether their state had expanded Medicaid. Participants from Medicaid expansion states were more likely to report an improved ability to provide high-quality care compared with participants from Medicaid nonexpansion states (50% vs 34%; P = .01). The average response to whether the ACA addresses the main barriers to HIV care was neutral and did not differ based on Medicaid status. The top 3 main barriers to HIV care cited were mental health, substance use, and transportation. Conclusions HIV clinicians in Medicaid expansion states were more likely to report an improved ability to provide high-quality care since ACA implementation compared with those in Medicaid nonexpansion states. However, HIV clinicians across the United States are concerned that the ACA does not address the main barriers to HIV care. To be successful, the “Ending the HIV Epidemic” initiative should address these identified barriers.
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Affiliation(s)
- Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.,Center for Health Policy, University of Virginia, Charlottesville, Virginia, USA
| | - Joshua Ferey
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Elizabeth Farrell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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McManus KA, McManus K, Dillingham R. National Survey of United States Human Immunodeficiency Virus Medical Providers' Knowledge and Attitudes About the Affordable Care Act. Clin Infect Dis 2019; 67:1403-1410. [PMID: 30165397 PMCID: PMC6186859 DOI: 10.1093/cid/ciy296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/20/2018] [Indexed: 11/23/2022] Open
Abstract
Background The Affordable Care Act (ACA) affects United States’ healthcare by offering Medicaid expansion and tax subsidies to persons with low incomes, and its interaction with the current human immunodeficiency virus (HIV) healthcare delivery system is complex. The objective was to explore HIV medical providers’ knowledge and attitudes about the ACA. Methods HIV medical providers were emailed a weblink to a survey. Descriptive statistics, Mann-Whitney U tests, and binary logistic regression were performed. Results Of the 253 survey participants, the majority (61%) answered all 4 knowledge questions correctly. About 70% knew whether or not their state had decided to expand Medicaid. About 1 in 10 did not know if the ACA eliminated the Ryan White Program. When rating whether the ACA would improve their patients’ HIV outcomes from 1–5 with 5 as “strongly agree,” the providers’ mean responses varied by state Medicaid status: 3.78 (standard deviation [SD], 0.83) for Medicaid expansion compared with 3.37 (SD, 1.00) for Medicaid nonexpansion (P = .002). Adjusting for medical provider type, years of HIV practice, and sources of ACA information, correct ACA knowledge was associated with providing care in a Medicaid nonexpansion state (adjusted odds ratio [aOR], 2.07; 95% confidence interval [CI], 1.11–3.88), obtaining knowledge from case managers (aOR, 1.89; 95% CI, 1.03–3.48), and obtaining knowledge from newspapers/magazines (aOR, 1.94; 95% CI, .99–3.81). Conclusions Medical providers in Medicaid expansion states were more optimistic about the ACA’s likelihood to improve their patients’ HIV outcomes. There are gaps in HIV medical providers’ understanding of the ACA. Education could enhance systems-based practice.
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Affiliation(s)
- Kathleen A McManus
- Division of Infectious Diseases and International Health, Charlottesville.,Center for Health Policy, University of Virginia, Charlottesville
| | | | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, Charlottesville
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Lee K, Wright SM, Wolfe L. The clinically excellent primary care physician: examples from the published literature. BMC FAMILY PRACTICE 2016; 17:169. [PMID: 27964709 PMCID: PMC5153856 DOI: 10.1186/s12875-016-0569-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/30/2016] [Indexed: 11/10/2022]
Abstract
Clinical excellence is the ultimate goal in patient care. Exactly what the clinically excellent primary care physician (PCP) looks like and her characteristics have not been explicitly described. This manuscript serves to illustrate clinical excellence in primary care, using primarily case reports exemplifying physicians delivering holistic and patient-centred care to their patients. With an ever increasing demand for accessible and accountable health care, an understanding of the qualities desirable in primary care providers is now especially relevant.A literature review was conducted to identify compelling stories showing how excellent PCPs care for their patients. In the 2397 published works reviewed, we were able to find case reports and studies that exemplified every domain of the description of clinical excellence proposed and published by the Miller Coulson Academy of Clinical Excellence (MCACE). After reviewing these reports, the authors felt that the domains of excellence, as described by the MCACE, are practically applicable and relevant for primary care physicians. It is our hope that this paper prompts readers to reflect on clinical excellence in primary care.
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Affiliation(s)
- Kimberley Lee
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave., Mason F. Lord Center Tower, 2nd Floor, Baltimore, 21224, MD, USA
| | - Scott M Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave., Mason F. Lord Center Tower, 2nd Floor, Baltimore, 21224, MD, USA.
| | - Leah Wolfe
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave., Mason F. Lord Center Tower, 2nd Floor, Baltimore, 21224, MD, USA
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