CAPABLE: A Scoring System Utilizing Patient-Reported Measures to Evaluate Patient Experience After Mohs Surgery.

BACKGROUND: Patient experience metrics are gaining prominence in health care. We introduce the CAPABLE survey to assess postoperative experiences of Mohs surgery patients. OBJECTIVE: We sought to determine whether CAPABLE scores aligned with overall patient satisfaction in Mohs surgery. METHODS: This was a cross-sectional, survey-based study of patients presenting for their first postoperative visit after Mohs surgery. The CAPABLE survey included questions on postoperative instructions, activity limitations, pain control, provider accessibility, and bleeding, followed by 2 overall satisfaction questions taken from the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems survey. The pilot study took place at the University of Texas Dell Medical School (DMS), followed by a validation study ( n = 206) at DMS and Oregon Health and Science University (OHSU). We assessed for correlations between CAPABLE scores and overall satisfaction. RESULTS: In the pilot study ( n = 137), overall CAPABLE scores and scores of individual CAPABLE components correlated positively with overall satisfaction.In the multisite validation study ( n = 206) spanning DMS and OHSU, CAPABLE scores correlated positively with overall satisfaction. CONCLUSION: The CAPABLE survey is a concise tool for assessing specific, actionable components of the postoperative patient experience in Mohs surgery, while correlating with overall patient satisfaction.

A Conservative Treatment to Address Functional and Esthetic Concerns Adolescents.

When treating a patient with esthetic concerns, it is important to understand the patient's viewpoint about their smile, including their likes and dislikes. As is often emphasized at the Kois Center, clinicians need to know whether the patient desires the smile they used to have or the smile that they never had. The distinction is critical, and in the case presented the patient felt her smile had always appeared childlike because her teeth were particularly small. In her case, she wanted the smile she never had. The patient also expressed concerns about how her teeth fit together. Before an esthetic plan was created, a systematic diagnosis of the patient's periodontal, biomechanical, functional, and dentofacial risks with their associated prognoses was required. Once the case was diagnosed, a conservative treatment plan was created to minimize risk so the outcome would be predictable and long-lasting.

Association of Tumor Characteristics With Insurance Type Among Patients Undergoing Mohs Micrographic Surgery for Nonmelanoma Skin Cancer.

Importance: Little is known about the association between insurance type and tumor or treatment characteristics among patients undergoing Mohs micrographic surgery (MMS) for nonmelanoma skin cancer (NMSC). Objective: To investigate whether there are differences in tumor and treatment characteristics among patients undergoing MMS for NMSC by insurance type. Design, Setting, and Participants: This retrospective cohort study included patients with NMSC who presented for surgery at an academic MMS practice between May 2017 and May 2019. Main Outcomes and Measures: Preoperative and postoperative tumor diameters, number of MMS stages, type of closure, and number of high-risk tumors were compared based on insurance type among uninsured and underinsured patients and those with private insurance, Medicare, and Veterans Affairs (VA) insurance. Results: A total of 1397 patients with NMSC (978 [70%] male; mean [SD] age, 68.5 [12.4] years) underwent 1916 MMS procedures. Of these patients, 868 (45%) had Medicare, 570 (30%) had private insurance, 299 (16%) had VA insurance, and 179 (9%) were treated at a safety net clinic or were uninsured. Compared with patients with private insurance, uninsured and underinsured patients had significantly larger preoperative tumor bed diameters (difference, 28%; 95% CI, 14%-43%; P < .001) and postoperative defect sizes (difference, 28%, 95% CI, 16%-41%; P < .001). Patients with Medicare and VA insurance did not have significantly different preoperative tumor bed diameters compared with patients with private insurance. Patients with VA insurance had larger postoperative defect sizes than patients with private insurance (difference, 12%; 95% CI, 2%-23%; P = .02). The number of MMS stages and type of closure did not significantly differ based on insurance type. Conclusions and Relevance: In this cohort study of patients undergoing MMS for NMSC, larger preoperative tumor and postoperative defect sizes were associated with being uninsured or underinsured compared with privately insured. Future studies are required to determine why these differences exist to deliver optimal care to all patients.

Review and Update on Evidence-Based Surgical Treatment Recommendations for Nonmelanoma Skin Cancer.

Nonmelanoma skin cancer (NMSC) is the most commonly diagnosed malignancy in the United States. Surgery is considered the gold standard treatment. Techniques include curettage and electrodesiccation, surgical excision, and Mohs micrographic surgery. While each is effective, there are relative advantages and disadvantages with respect to cost, time, quality of life, and role in patients with limited life expectancy. Preventing local tumor recurrence is the primary objective; however, recurrence rates are based on retrospective data, and high-quality comparator studies assessing effectiveness are scarce. Prospective and randomized controlled trials are imperative to create comprehensive, evidence-based recommendations for the surgical management of NMSC.