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Liu, Kristina

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Liu

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Kristina

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Liu, Kristina
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    Risk of Developing Pyoderma Gangrenosum after Procedures in Patients with a Known History of Pyoderma Gangrenosum – A Retrospective Analysis
    (Elsevier BV, 2017) Xia, Fandi; Liu, Kristina; Lockwood, Stephen J.; Butler, Daniel Charles; Tsiaras, William; Joyce, Cara; Mostaghimi, Arash
    Background The risk of postoperative pyoderma gangrenosum (PG) in patients with a known history of PG is unknown. Objective To quantify risk and identify patient/procedure-related risk factors for postsurgical PG recurrence/exacerbation in patients with known history of PG. Methods We retrospectively evaluated the likelihood of postsurgical PG recurrence/exacerbation for all patients with a confirmed diagnosis of PG at Brigham & Women’s Hospital and Massachusetts General Hospital from 2000-2015. Results 5.5% (n=33) of procedures led to recurrence of PG in 15.1% (n=25) of patients. Compared to skin biopsy, small open surgeries had an adjusted odds ratio (aOR) of 8.65 (1.55, 48.33) for PG recurrence/exacerbation; large open surgeries had an aOR of 5.97 (1.70, 21.00); and Mohs surgery/skin excision had an aOR of 6.47 (1.77, 23.61). PG chronically present at the time of procedure had an aOR of 4.58 (1.72, 12.22). Immunosuppression, time elapsed since original PG diagnosis, and procedure location did not significantly influence risk. Limitations Our study is limited by its retrospective nature and relatively small sample size. Conclusion There is a small but clinically meaningful risk of postsurgical PG recurrence/exacerbation in patients with known history of PG; higher risks occur with more invasive procedures and chronically present PG.
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    Modeling the Effect of Shared Care to Optimize Acne Referrals From Primary Care Clinicians to Dermatologists
    (American Medical Association (AMA), 2016) Liu, Kristina; Hartman, Rebecca; Joyce, Cara; Mostaghimi, Arash
    Importance Access to dermatologists remains a nationwide challenge. Optimizing referrals to a dermatologist may reduce patient wait times. Objective To model the effect of algorithm-based acne treatment by primary care clinicians on referral patterns and costs. Design, Setting, and Participants Overall, 253 referrals from primary care clinicians to dermatologists for acne from January 2014 through March 2015 were reviewed at Brigham and Women’s Hospital. No-show rate, diagnostic concordance between primary care clinicians and dermatologists, treatment at the time of referral, and treatment by a dermatologist were ascertained, and we modeled 2 treatment algorithms—initiation of topical treatments by primary care clinicians (algorithm A) and initiation of topical treatments and oral antibiotics by primary care clinicians (algorithm B)—to identify the most effective referral patterns and costs. Main Outcomes and Measures The primary outcome was the elimination of unnecessary appointments with a dermatologist. Secondary outcomes included reduction in delay to treatment, health care cost savings, and decrease in no-show rate. Results Overall, 150 of 253 referred patients were seen and treated by a dermatologist; 127 patients (50.2%) were not on prescription acne treatment at the time of dermatology referral. Model A reduced initial referrals in 72 of 150 cases (48.0%), eliminated referrals in 60 of 150 cases (40%), and reduced average delay-to-treatment by 28.6 days. This resulted in cost savings of $20.28 per patient, reduction of wait time by 5 days per patient, and decreased the no-show rate by 13%. Model B reduced initial referrals in 130 of 150 cases (86.7%), eliminated referrals in 108 of 150 cases (72%), and reduced average delay-to-treatment by 27.9 days. This resulted in cost savings of $35.68 per patient, shortened wait-time by 9 days per patient, and decreased the no-show rate by 24%. Conclusions and Relevance Algorithm-based treatment of acne by primary care clinicians may eliminate unnecessary appointments, reduce wait time for treatment, lower costs, and reduce patient no-shows.