Zhang Myron, Zippin Jonathan, Kaffenberger Benjamin
Department of Internal Medicine, Summa Akron City Hospital, Akron, Ohio.
Department of Dermatology, Weill Cornell Medicine, New York, New York.
JAMA Dermatol. 2018 Sep 1;154(9):1040-1044. doi: 10.1001/jamadermatol.2018.1768.
Advanced practice professionals (APPs) such as nurse practitioners and physician assistants independently perform a large number and variety of dermatologic procedures, but little is known about how the number and scope of these procedures have changed over time.
To examine the trends in scope and volume of dermatology procedures billed by APPs over time.
DESIGN, SETTING, AND PARTICIPANTS: A longitudinal study was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. The data encompass nearly all outpatient procedures paid by Medicare Part B in the United States and include the type of clinician under which procedures were billed.
For each type of dermatology procedure, the total number performed by APPs and the total number performed by dermatologists each year.
The total number (and percentage) of all dermatologic procedures performed by APPs increased from 2.69 million of 30.7 million (8.8%) in 2012 to 4.54 million of 33.9 million (13.4%) in 2015. The most common procedures performed by APPs in 2015 were destructions of benign neoplasms (3.6 million), biopsies (788 834), and destructions of malignant neoplasms (48 982). The numbers of patch tests, removals of benign and malignant neoplasms, intermediate and complex repairs, flaps, and surgical pathologic specimen examinations by APPs also increased each year from 2012 through 2015.
The number and scope of dermatologic procedures performed by APPs appear to be increasing over time. These procedures can be difficult and invasive. This study suggests that further studies are needed to determine what association these procedures have with patient outcomes and the potential need for more formal training.
高级执业专业人员（APPs），如执业护士和医师助理，独立开展大量且种类繁多的皮肤科手术，但对于这些手术的数量和范围随时间如何变化，人们了解甚少。
研究APPs所开具账单的皮肤科手术范围和数量随时间的变化趋势。
设计、地点和参与者：使用2012年至2015年医疗保险提供者利用和支付数据：医师及其他供应商公共使用文件进行了一项纵向研究。这些数据涵盖了美国医疗保险B部分支付的几乎所有门诊手术，并包括开具手术账单的临床医生类型。
对于每种皮肤科手术类型，每年APPs执行的总数和皮肤科医生执行的总数。
APPs执行的所有皮肤科手术总数（及百分比）从2012年的269万例（占3070万例的8.8%）增加到2015年的454万例（占3390万例的13.4%）。2015年APPs执行的最常见手术是良性肿瘤切除术（360万例）、活检（788834例）和恶性肿瘤切除术（48982例）。从2012年到2015年，APPs进行的斑贴试验、良性和恶性肿瘤切除术、中级和复杂修复术、皮瓣手术以及手术病理标本检查的数量也逐年增加。
随着时间的推移，APPs进行的皮肤科手术数量和范围似乎在增加。这些手术可能难度较大且具有侵入性。本研究表明，需要进一步研究以确定这些手术与患者预后的关联以及对更正规培训的潜在需求。
