RESEARCH ARTICLE


Towards Developing Strategies to Reduce Health Care Costs in Dermatology



Mahsa Amir1, §, Jeffrey H. Dunn1, §, Melanie R. Bui1, P. Alex McNally4, Laura Huff1, Sofia Mani1, Ashley Hamstra5, Jodi Duke2, Robert Dellavalle*, 1, 3
1 University of Colorado School of Medicine, Aurora, CO, USA
2 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
3 Dermatology Service, Department of Veterans Affairs Medical Center, Denver, CO, USA
4 University of Colorado School of Medicine, Department of Surgery, CO, USA
5 Loma Linda University Medical Center, Department of Dermatology, CA, USA


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Creative Commons License
© 2012 Amir et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Veteran Affairs Medical Center, 1055 Clermont Street, Box 165, Denver, CO 80220, USA; Tel: (303) 399-8020, Ext. 2475; Fax: (303) 393-4686; E-mail:robert.dellavalle@ucdenver.edu
# The first two authors listed contributed equally to this work


Abstract

Background:

The American Board of Internal Medicine has challenged medical specialties to develop “Top Five” lists in order to identify potential areas of wasted health care resources. The American Academy of Dermatology has not yet developed a “Top Five” list.

Objective:

To provoke discussion on the need for more evidence, guidelines, and quality measures to reduce waste in Dermatology.

Methods:

Dermatologists and medical professionals attending the 2010 Cochrane Skin Group Annual meeting were invited to complete a short-answer survey.

Results:

The study had a response rate of 39% (n=24). Most responses fit under a common theme related to the lack of, and poor adherence to evidence-based guidelines including lack of randomized controlled trials for treatment of prevalent skin disease, use of expensive biologics, antibiotics or procedures when cheaper treatment alternatives exist, the use of screening or diagnostic procedures for diseases for which no effective treatment exists, inappropriate diagnostics (biopsies, allergy tests) or treatments (excision of benign lesions, inappropriate Mohs surgery) of skin diseases and lastly, inappropriate dermatology referrals from PCPs.

Limitations:

The survey sample is small and limited to a small subset of medical professionals familiar with dermatology. While not definitive the survey results inspired this commentary and provided an initial basis for further discussion.

Conclusion:

This commentary and survey are intended to encourage discussion regarding development of a “Top Five” list of ways to improve dermatology quality and efficiency.

Keywords: Quality, efficiency, evidence-based medicine, health care reform, ethics, economics.