ABSTRACT
BACKGROUND
Studies of dermatologic inpatients are important, given the rise in the number of admissions and of Medicare spending for dermatology-specific and dermatology-related diagnosis related groups (DRGs) in recent years. Yet inpatient studies of patients admitted for skin conditions have mainly focused on dermatology consults, which neglect the experiences of patients not seen by dermatology. Identifying patients based on DRG codes includes all patients admitted for skin conditions and therefore allows for a more comprehensive analysis of the dermatologic care delivered.
OBJECTIVES
Our primary aim was to characterize the care of all patients admitted for a skin-related condition using dermatology DRGs. Our secondary aim was to assess the impact of a dermatology consult for those patients for whom a consult was called.
DESIGN AND PARTICIPANTS
We conducted a retrospective chart review of 512 inpatient admissions assigned a dermatology-specific or dermatology-related DRG over fiscal year 2009 at an academic medical center in Boston. Comparisons were made between patients with and without dermatology consults.
MAIN MEASURES
Dermatology DRG admission and consult rates. For consults, frequency of dermatologic procedures performed, treatment recommendations made, changes in diagnoses, and readmissions.
KEY RESULTS
Dermatology was consulted in 51 % of cases for dermatology-specific DRGs and in 3 % of cases for dermatology-related DRGs. Dermatology was consulted mainly for common dermatoses such as drug eruptions and cellulitis; among all cellulitis patients, 5 % received a dermatology consult. The most frequent interventions performed were skin biopsies, topical steroid recommendations, and nursing education on skin care. Dermatology consults changed the diagnosis in 45 % of cases.
CONCLUSIONS
Dermatologists were often not consulted for the care of patients with dermatology-related DRGs. When dermatologists were consulted, we found an impact on both diagnosis and management.
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REFERENCES
MEDPAR [Internet]. Baltimore (MD): Centers for Medicare & Medicaid Services. 2008—. [updated 2012 Mar 10; cited 2012 Aug 05]. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareFeeforSvcPartsAB/MEDPAR.html.
Kirsner RS, Yang DG, Kerdel FA. The changing status of inpatient dermatology at American academic dermatology programs. J Am Acad Dermatol. 1999;40(5 Pt 1):755–7.
Kirsner RS, Yang DG, Kerdel FA. Dermatologic disease accounts for a large number of hospital admissions annually. J Am Acad Dermatol. 1999;41(6):970–3.
Falanga V, Schachner LA, Rae V, et al. Dermatologic consultations in the hospital setting. Arch Dermatol. 1994;130(8):1022–5.
Bauer J, Maroon M. Dermatology inpatient consultations: a retrospective study. J Am Acad Dermatol. 2010;62(3):518–9.
Davila M, Christenson LJ, Sontheimer RD. Epidemiology and outcomes of dermatology in-patient consultations in a Midwestern U.S. university hospital. Dermatol Online J. 2010;16(2):12.
Sherertz EF. Inpatient dermatology consultations at a medical center. Arch Dermatol. 1984;120(9):1137.
Balagula Y, Rosen ST, Lacouture ME. The emergence of supportive oncodermatology: the study of dermatologic adverse events to cancer therapies. J Am Acad Dermatol. 2011;65(3):624–35.
Helms AE, Helms SE, Brodell RT. Hospital consultations: time to address an unmet need? J Am Acad Dermatol. 2009;60(2):308–11.
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Disclosures: Lissy Hu: none; Dawn Ferrazza: none; Harley Haynes: outpatient and inpatient dermatologist; Thomas Kupper: outpatient and inpatient dermatologist; Abrar Qureshi: Abbott, CDC, Janssen, Novartis, Amgen, outpatient and inpatient dermatologist.
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Hu, L., Haynes, H., Ferrazza, D. et al. Impact of Specialist Consultations on Inpatient Admissions for Dermatology-Specific and Related DRGs. J GEN INTERN MED 28, 1477–1482 (2013). https://doi.org/10.1007/s11606-013-2440-2
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DOI: https://doi.org/10.1007/s11606-013-2440-2