Open AccessDermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana
Author(s) -
Victoria Williams,
Mohan Narasimhamurthy,
Olaf Rodriguez,
Karen Itumeleng Mosojane,
Thapelo Bale,
Koorileng Kesalopa,
Mukendi Kayembe,
Surbhi Grover
Publication year - 2019
Publication title -
journal of global oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.002
H-Index - 17
ISSN - 2378-9506
DOI - 10.1200/jgo.19.00181
Subject(s) - medicine , interquartile range , biopsy , sarcoma , psychological intervention , retrospective cohort study , histology , teledermatology , skin cancer , cancer , dermatology , health care , surgery , pathology , telemedicine , nursing , economics , economic growth
PURPOSE Kaposi sarcoma (KS) is an HIV-associated skin cancer that is highly prevalent in Botswana and associated with significant morbidity and mortality. Histopathology-confirmed diagnosis is required for chemotherapeutic interventions in Botswana, which creates barriers to care because of limited biopsy and pathology services. We sought to understand the role a dermatology specialist can play in improving KS care through quality improvement (QI) initiatives to reduce histologic turnaround times (TATs) for KS.METHODS Employment of a dermatology specialist within a public health care system that previously lacked a local dermatologist generated quality improvements in KS care. Retrospective review identified patients diagnosed with KS by skin biopsy in the predermatology QI interval (January 1, 2015, to December 31, 2015) versus the postdermatology QI interval (January 1, 2016, to November 31, 2017). Histology TATs and clinical characteristics were recorded. A t test compared the median histology TATs in the pre- and post-QI intervals.RESULTS A total of 192 cases of KS were diagnosed by skin biopsy. Sixty percent of patients were male with a median age of 39 years; nearly all were HIV-positive (98.4%). Median TAT in the postdermatology QI interval was 11 days (interquartile range, 12-23 days) compared with 32 days in the predermatology QI interval (interquartile range, 24-56 days; P < .00).CONCLUSION Dermatology-led QI initiatives to improve multispecialty care coordination can significantly decrease histology TATs for KS. The reduction of diagnostic delays is a key first step to decreasing the morbidity and mortality associated with this cancer in resource-limited settings.