Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System
Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System
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DOI：
10.1001/jamadermatol.2018.0212
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发表时间：
2018-05-01
期刊：
影响因子：
10.9
通讯作者：
Ferris, Laura K.
中科院分区：
文献类型：
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作者：
Anderson, Alyce M.;Matsumoto, Martha;Ferris, Laura K.
重要医师助理(PAS)越来越多地被用于皮肤科实践中诊断皮肤癌，尽管到目前为止，与委员会认证的皮肤科医生相比，他们诊断皮肤癌的准确性还没有得到很好的研究。目的比较PAS和皮肤科医生对皮肤癌诊断的准确性。设计、设置和参与者2011年1月1日至2015年12月31日在匹兹堡大学医学中心附属皮肤科办公室接受皮肤癌筛查的20 270名患者的33 647次皮肤癌筛查的病历回顾。国际疾病分类第九版代码V76.43和国际疾病及相关健康问题分类第十版代码Z12.83用于识别皮肤科医生和皮肤科医生进行的皮肤癌筛查的病理报告。诊断皮肤癌(非黑色素瘤、侵袭性黑色素瘤或原位黑色素瘤)的主要结果和需要活检的措施数(NNB)。结果20 270例患者中，女性12 722例(62.8%)，首次就诊时平均年龄(SD)为52.7(17.4)岁，19515名患者(96.3%)自我报告自己的种族/民族为非西班牙裔白人。对于1例皮肤癌的诊断，PAS的NNB为3.9，皮肤科医生为3.3(P<；.001)。根据诊断的黑色素瘤，PAS的NNB值为39.4，皮肤科医生的NNB值为25.4(P=0.007)。通过PA筛查的患者被诊断为原位黑色素瘤的可能性显著低于皮肤科医生筛查的患者(1.1%对1.8%就诊，P=.02)，但对于侵袭性黑色素瘤(0.7%对0.8%就诊，P=.83)或非黑色素瘤皮肤癌(6.1%对6.1%，P=.98)，差异并不显著。结论与皮肤科医生相比，PAS对皮肤癌确诊病例进行了更多的皮肤活检，而对原位黑色素瘤的诊断较少，这表明PAS的诊断准确率可能低于皮肤科医生。尽管PAS的可获得性可能有助于增加获得护理的机会和减少预约的等待时间，但这些发现对皮肤科PAS和其他非内科医生的培训、适当的执业范围和监督具有重要意义。(C)2018年美国医学会。版权所有。
IMPORTANCE Physician assistants (PAs) are increasingly used in dermatology practices to diagnose skin cancers, although, to date, their diagnostic accuracy compared with board-certified dermatologists has not been well studied.OBJECTIVE To compare diagnostic accuracy for skin cancer of PAs with that of dermatologists.DESIGN, SETTING, AND PARTICIPANTS Medical record review of 33 647 skin cancer screening examinations in 20 270 unique patients who underwent screening at University of Pittsburgh Medical Center-affiliated dermatology offices from January 1, 2011, to December 31, 2015. International Classification of Diseases, Ninth Revision code V76.43 and International Classification of Diseases and Related Health Problems, Tenth Revision code Z12.83 were used to identify pathology reports from skin cancer screening examinations by dermatologists and PAs.EXPOSURE Examination performed by a PA or dermatologist.MAIN OUTCOMES AND MEASURES Number needed to biopsy (NNB) to diagnose skin cancer (nonmelanoma, invasive melanoma, or in situ melanoma).RESULTS Of 20 270 unique patients, 12 722 (62.8%) were female, mean (SD) age at the first visit was 52.7 (17.4) years, and 19 515 patients (96.3%) self-reported their race/ethnicity as non-Hispanic white. To diagnose 1 case of skin cancer, the NNB was 3.9 for PAs and 3.3 for dermatologists (P < .001). Per diagnosed melanoma, the NNB was 39.4 for PAs and 25.4 for dermatologists (P = .007). Patients screened by a PA were significantly less likely than those screened by a dermatologist to be diagnosed with melanoma in situ (1.1% vs 1.8% of visits, P = .02), but differences were not significant for invasive melanoma (0.7% vs 0.8% of visits, P = .83) or nonmelanoma skin cancer (6.1% vs 6.1% of visits, P = .98).CONCLUSIONS AND RELEVANCE Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. Although the availability of PAs may help increase access to care and reduce waiting times for appointments, these findings have important implications for the training, appropriate scope of practice, and supervision of PAs and other nonphysician practitioners in dermatology. (C) 2018 American Medical Association. All rights reserved.