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203 results on '"Cwalina, Thomas B."'

14. Outpatient dermatology appointment wait times for United States military veterans, 2014–2021.

Author

Zheng, David X., Cwalina, Thomas B., Friedl, Sophia L., Jella, Tarun K., Bullock, Taylor A., Xiang, Laura, and Levoska, Melissa A.

Subjects
*VETERANS, *DATA warehousing, *MILITARY policy, *VETERANS' health, UNITED States armed forces
Abstract

Trends in outpatient dermatology appointment wait times for United States (US) veterans are poorly characterized. Given concerns surrounding prolonged wait times at Veterans Health Administration (VHA) medical facilities, the federal government introduced the Maintaining Internal Systems and Strengthening Outside Networks (MISSION) Act in 2018, allowing veterans to receive VHA-reimbursed community care if VHA specialty care appointments cannot be scheduled within 28 days. Considering this expanded access to community care, we characterized among US veterans the (1) overall demand for dermatology appointments, (2) trends in average wait times, and (3) facility/geographic variation in wait times. The VHA Corporate Data Warehouse was queried for all dermatology appointments from January 1, 2014 to June 30, 2021. Appointment wait time, defined as time from appointment request to completion, was calculated for each care setting: VHA, community, and overall. Linear regression was used to assess average annual changes in wait times, and t-tests were used to compare mean wait times before and after the MISSION Act's implementation in 2018. Median wait times for each facility and state, and the proportion in each category meeting the MISSION Act goal wait time < 28 days, were determined using 2021 data. Our analytic cohort comprised 1,613,262 dermatology appointments directed through 130 VHA facilities. There was a 356% increase in demand for dermatology appointments from 2014 to 2019 (from 85,593 to 296,140 overall visits), with a corresponding 435% increase in demand for community appointments from 2014 to 2020 (from 11.7 to 50.9% of annual visits). Overall appointment wait times increased by an average 0.88 days annually, with community wait times increasing by an annual average of 1.09 days and VHA wait times decreasing by an annual average of 1.01 days (all P < 0.001). In 2021, 35% of VHA facilities and 20% of states had a median appointment wait time < 28 days. We observed an increase in demand over time for outpatient dermatology appointments among US veterans. Appointment wait times increased overall and in community settings, though decreased at VHA facilities. Understanding trends in appointment wait times will help refine policies aimed at increasing dermatologic care access for US veterans. [ABSTRACT FROM AUTHOR]

Published
2025
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29. Rural Communities in the United States Face Persistent Disparities in Access to Orthopaedic Surgical Care

Author

Wu, Victoria S., Schmidt, Jenna E., Jella, Tarun K., Cwalina, Thomas B., Freidl, Sophie L., Pumo, Thomas J., and Kamath, Atul F.

Subjects
Diversity
Abstract

BACKGROUND: Access to orthopaedic care across the United States (U.S.) remains an important issue, however, no recent study has examined disparities in rural access to orthopaedic care. The goals of the present study were to (1) investigate trends in the proportion of rural orthopaedic surgeons from 2013 to 2018 as well as the proportion of rural U.S. counties with access to such surgeons and (2) analyze characteristics associated with choice of a rural practice setting. METHODS: The study analyzed the Centers for Medicare and Medicaid Services (CMS) Physician Compare National Downloadable File (PC-NDF) for all active orthopaedic surgeons from 2013 to 2018. Rural practice settings were defined using Rural-Urban Commuting Area (RUCA) codes. Linear regression analysis investigated trends in rural orthopaedic surgeon volume. Multivariable logistic regression evaluated the association of surgeon characteristics with rural practice setting. RESULTS: The total number of orthopaedic surgeons increased 1.9%, from 21,045 (2013) to 21,456 (2018). Meanwhile, the proportion of rural orthopaedic surgeons decreased by roughly 0.9%, from 578 (2013) to 559 (2018). From a per capita perspective, the number of orthopaedic surgeons practicing in a rural setting per 100,000 population ranged from 4.55 orthopaedic surgeons per 100,000 in 2013 and 4.47 per 100,000 in 2018. Meanwhile, the number of orthopaedic surgeons practicing in an urban setting ranged from 6.63 per 100,000 in 2013 and 6.35 per 100,000 in 2018. The surgeon characteristics most associated with decreased odds of practicing orthopaedic surgery in a rural setting included earlier career-stage (OR: 0.80, 95% CI: [0.70-0.91]; p < 0.001) and sub-specialization status (OR: 0.40, 95% CI: [0.36-0.45]; p < 0.001). CONCLUSION: Existing rural-urban disparities in musculoskeletal healthcare access have persisted over the past decade and could worsen. Future research should investigate the effects of orthopaedic workforce shortages on travel times, patient cost burden, and disease specific outcomes. Level of Evidence: IV

Published
2023

35. Differences in scholarly productivity between allopathic, osteopathic and non-US international medical graduates matching into dermatology residency

Author

Vaccarello, Annalise, primary, Zheng, David X., additional, Narang, Jatin, additional, Gallo Marin, Benjamin, additional, Xu, James R., additional, Ouyang, Kelsey, additional, Ahmad, Areebah S., additional, Cwalina, Thomas B., additional, Scott, Jeffrey F., additional, Ho, Roger S., additional, and Sharma, Timmie R., additional

Published
2022
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37. Association of sociodemographic characteristics with utilization of sentinel lymph node biopsy for American Joint Committee on Cancer 8th edition T1b cutaneous melanoma.

Author

Zheng, David X., Ahmed, Fasih A., Levoska, Melissa A., Tripathi, Raghav, Mulligan, Kathleen M., Cwalina, Thomas B., Bordeaux, Jeremy S., Ruiz, Emily S., Rothermel, Luke D., Hoehn, Richard S., and Scott, Jeffrey F.

Subjects
SENTINEL lymph node biopsy, MELANOMA, RACE
Abstract

Sentinel lymph node biopsy (SLNB) is an important staging and prognostic tool for cutaneous melanoma (CM). However, there exists a knowledge gap regarding whether sociodemographic characteristics are associated with receipt of SLNB for T1b CMs, for which there are no definitive recommendations for SLNB per current National Comprehensive Cancer Network guidelines. We performed a retrospective analysis of the 2012–2018 National Cancer Database, identifying patients with American Joint Committee on Cancer staging manual 8th edition stage T1b CM, and used multivariable logistic regression to analyze associations between sociodemographic characteristics and receipt of SLNB. Among 40,458 patients with T1b CM, 23,813 (58.9%) received SLNB. Median age was 62 years, and most patients were male (57%) and non-Hispanic White (95%). In multivariable analyses, patients of Hispanic (aOR 0.67, 95%CI 0.48–0.94) and other (aOR 0.78, 95%CI 0.63–0.97) race/ethnicity, and patients aged > 75 (aOR 0.33, 95%CI 0.29–0.38), were less likely to receive SLNB. Conversely, patients in the highest of seven socioeconomic status levels (aOR 1.37, 95%CI 1.13–1.65) and those treated at higher-volume facilities (aOR 1.29, 95%CI 1.14–1.46) were more likely to receive SLNB. Understanding the underlying drivers of these associations may yield important insights for the management of patients with melanoma. [ABSTRACT FROM AUTHOR]

Published
2023
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