Implementing a Melanoma Risk Screening Tool in Primary Care

Abstract

Problem & Purpose: Full body skin cancer examinations (FBSE) are not being performed at a Baltimore City primary care practice. High-risk melanoma populations (i.e., 33.3% Caucasian, 62.5% Male, 25% Young Adult (20-39), 66.7% Adult (40-64), 8.3% Older Adult (65-79), 12.5% Caucasian & Young Adult, 8% Caucasian, Young Adult & Male) are present at the practice. The purpose of this quality improvement initiative is to implement the Williams Melanoma Self-Risk Screening Tool (WMT) to improve melanoma screening, identification, and management. Methods: To implement WMT the office manager (OM), medical director, and nurse practitioner will be educated by the project lead (PL) on how to utilize WMT. Staff will be checked off individually after completion of in-person training in the REDcap Training Compliance Tool by PL. After all staff are educated, implementation and data collection will start. All medical patients (ages 35-74) will be given WMT by the OM to complete upon arrival. WMT will be kept in the patient’s medical record. After form completion, the provider will review the screening tool and deem the patient as high/low risk. If the patient is high risk, the provider will refer the patient for FBSE. OM will enter data (patient name, date of birth (DOB), appointment day, if screening was performed, risk score (high/low), and if referral for FBSE was made) into the Data Summary Excel on the office computer. This data will be deidentified by OM and then sent to PL. PL will then enter the deidentified data into the REDcap Deidentified Data Summary for analysis. Results: 52.8% of eligible patients have been screened for melanoma risk using WMT. 5.6% of patients have been identified as high risk for melanoma. 100% of high-risk patients have been referred for FBSE. Conclusion: Findings suggest WMT may be a feasible screening tool for primary care. The outcome goal of referring 100% of high-risk patients for FBSE was met. The process goal of screening 100% of patients was not met using WMT. Staff have reported competing factors (i.e.: new staff, changes to billing practices) as barriers to screening. Screening increased overtime as staff become accustomed to the practice change.