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- Presentation
Improving Dermatology Access Through Quality Improvement and Supply-Demand Balance
Description
The speaker introduces a new dermatology quality improvement focus on improving access, emphasizing that access problems are a major specialty-wide issue and that solutions should be shared across practices. A memorable case of a patient whose lesion was triaged as benign but later proved to be invasive melanoma illustrates how delayed access, language barriers, and insurance limitations can lead to serious harm. The talk reviews common causes of long waits and scheduling problems, including no-shows, overbooking, limited appointment types, reliance on staff to triage referrals, geographic maldistribution of dermatologists, and disparities by insurance, practice setting, and patient population. It highlights the concept of advanced access and the need to balance supply, demand, and backlog by measuring referral volume, available slots, and wait times. In the speaker’s own academic practice, demand exceeds available routine and follow-up capacity, with many slots reserved for urgent or subspecialty care and some remaining unused, contributing to long delays. Proposed solutions include workflow optimization, rapid or urgent access clinics, teledermatology, e-consults, use of APPs, and technology-driven scheduling improvements. The speaker concludes that many clinicians are already doing QI informally and encourages understanding local supply-demand dynamics, using data to guide interventions, and sharing successful access projects.
View moreConclusions
- Dermatology access problems are driven by mismatches between supply, demand, and how appointments are allocated rather than by demand alone.
- Long wait times and limited access disproportionately affect Medicaid patients, rural patients, veterans, refugees, pediatric patients, and other special populations.
- Simple triage systems can misclassify serious disease, as illustrated by delayed recognition of melanoma when a lesion was assumed to be benign.
- Many clinics have unused appointment capacity even while patients wait months, showing that backlog can persist despite available supply.
- Improving access requires examining demand, supply, and backlog at each practice site instead of assuming one-size-fits-all solutions.
- Rapid access clinics, teledermatology, eConsults, referral-only policies, and workflow redesign can substantially reduce wait times.
- Advanced access scheduling aims to balance available visits with patient need so patients can be seen when they need care.
- Technology, allied health support, and clinic-hour redesign are promising tools for improving access, but the best intervention depends on the specific access problem.
- Quality improvement methods are useful for access work, and clinicians can be doing QI even if they do not formally label it that way.
- The most actionable next step for many practices is to measure their own demand, supply, and backlog and use those data to guide change.
- Jayakumar 2018
- Finstad 2022
- Seiger 2020
- Herd 2017
- O'Brien 2016