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Patient-Reported Outcomes in Patients Undergoing Mohs Micrographic Surgery
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersFew studies exist on patient-reported outcome measures and Mohs micrographic surgery (MMS). As the Center for Medicare and Medicaid Services has prioritized incorporating patient-reported outcome measures into quality measures, it is imperative to differentiate patient-reported problems from physician-reported complications and understand their evolution over time.1
Additional Info
Disclosure statements are available on the authors' profiles:
Patient reported outcome measures in patients undergoing Mohs micrographic surgery: Timing matters
J Am Acad Dermatol 2021 Sep 25;[EPub Ahead of Print], T Evans, E Lee, A Wysong, A SuttonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Patient-reported outcome perceptions are the “work product” as defined by the patient. The “complications” as would be expected in the hands of competent dermatologic surgeons are minor and usually self-limited, but still important as they are upsetting to the patient. As the authors note, the outcomes are important as CMS is using them as quality measures and will do so more in the future as a way of tamping down reimbursements.
As Mohs and dermatologic surgeons, we lag behind other areas of dermatology where many measures, including patient-reported outcomes, have been discussed for years. A visit to https://dermoutcomes.org/, the home page for “International Dermatology Outcome Measures group,” is a resource the curious reader should visit. (Disclosure: I serve on the IDEOM board of directors.) Originally focused only on inflammatory skin diseases, IDEOM now has workgroups in acne, actinic keratosis, alopecia areata, cutaneous T-cell lymphoma, hidradenitis suppurativa, itch, psoriatic disease, and vitiligo leading the way. Maybe these authors might want to email our executive director ([email protected]) and offer to set up a Mohs surgery work group? They would be welcomed!
Never one to miss an opportunity to educate, I do wonder if the patient outcomes might have been influenced by pre- and intraoperative education. If you truly sell the patient the “worst case scenario” (expect bruising, pain, itching, etc) and they have less than advertised, they might perceive most minor and self-limited “complications” as less unpleasant than advertised and might not even think of them as such. Other measures, such as limiting cautery close to wound edges, as I tell patients I try to do, to avoid a multitude of “cooking burns” that only become apparent when the anesthesia wears off, is a clinical pearl. Maintenance-free dressing such as gentian violet, Steri-Strips™, a hydrocolloid dressing, and a cover of a permeable membrane dressings, always topped off with a pressure dressing for as long as the patient can tolerate, minimizes these “complications.”
As I remind my residents every day, your worst nightmare as a dermatologic surgeon is a waiting room full of patients all in to see you for complications you wrought. Also, a happy patient who suffered less than expected can be your best advertising—far less expensive and time consuming than a social media presence.