title: Temporal trends in healthcare utilization following primary melanoma diagnosis among Medicare beneficiaries.
abstract: BACKGROUND
  Little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time.
  
  
  OBJECTIVE
  To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis.
  
  
  METHODS
  We conducted a before-and-after multiple time series study of Medicare beneficiaries aged ≥ 66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results Medicare database. Primary exposure was time from primary melanoma diagnosis at 3-6 months and 6-24 months postdiagnosis. Covariates included tumour-, patient- and geographical-level characteristics and healthcare utilization in the 6 months before diagnosis. Poisson regression was used to estimate population-based risk-adjusted utilization rates for skin biopsies, benign skin excisions, internal medicine office visits and dermatology office visits.
  
  
  RESULTS
  The study population included 56 254 patients with first diagnoses of primary melanoma. Most patients were ≥ 75 years old (56·8%), male (62·1%), and had in situ melanoma (42·4%) or localized invasive melanoma (45·9%). From 2000 to 2009, risk-adjusted skin biopsy rates 24 months postdiagnosis increased from 358·3 to 541·3 per 1000 person-years (P < 0·001), and dermatology visits increased from 989·0 to 1535·6 per 1000 person-years (P < 0·001). Benign excisions and internal medicine visits remained stable. In 2000, risk-adjusted skin biopsy rates 6 months postdiagnosis increased by 208·5 relative to the 6 months before diagnosis (148·7 vs. 357·2) compared with an observed absolute increase of 272·5 (290·9 vs. 563·1) in 2009. Trends in dermatology visits were similar.
  
  
  CONCLUSIONS
  Utilization of skin biopsies and dermatology office visits following primary melanoma diagnosis has increased substantially over time. These results may inform optimization of care delivery for melanoma within the Medicare population.
authors.affiliation: Cornell Scott-Hill Health Center, New Haven, CT, U.S.A.
authors.forename: J P
authors.initials: JP
authors.lastname: Lott
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.|Norris Cotton Cancer Center, Lebanon, NH, U.S.A.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Norris Cotton Cancer Center, Lebanon, NH, U.S.A.|Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
authors.forename: L J
authors.initials: LJ
authors.lastname: Titus
authors.affiliation: Norris Cotton Cancer Center, Lebanon, NH, U.S.A.|Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.|Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
authors.forename: T
authors.initials: T
authors.lastname: Onega
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, OR, U.S.A.|Department of Medical Informatics, Oregon Health & Science University, Portland, OR, U.S.A.|Department of Clinical Epidemiology and Medicine, Oregon Health & Science University, Portland, OR, U.S.A.|Providence Cancer Center, Providence Health and Services, Portland, OR, U.S.A.
authors.forename: H D
authors.initials: HD
authors.lastname: Nelson
authors.affiliation: Dermatoepidemiology Unit, US Department of Veterans Affairs Medical Center, Providence, RI, U.S.A.|Department of Dermatology, Rhode Island Hospital, Providence, RI, U.S.A.|Department of Dermatology, Brown University School of Medicine, Providence, RI, U.S.A.|Department of Epidemiology, Brown University School of Medicine, Providence, RI, U.S.A.
authors.forename: M A
authors.initials: MA
authors.lastname: Weinstock
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, U.S.A.
authors.forename: J G
authors.initials: JG
authors.lastname: Elmore
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.|Norris Cotton Cancer Center, Lebanon, NH, U.S.A.|Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, U.S.A.
authors.forename: A N A
authors.initials: ANA
authors.lastname: Tosteson
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008545:Melanoma / Q000628:therapy*; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D018426:SEER Program; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000628:therapy*; D014481:United States