NEW YORK (Reuters Health)—Inpatient dermatology consultations were associated with shorter hospital stays and reduced readmissions in a U.S. medical center and may do the same elsewhere, researchers in Ohio suggest.
“A few decades ago, patients with severe psoriasis, drug reactions, blistering diseases and even severe eczema would be admitted to the hospital under close dermatology supervision. Now, very few hospitals that do not have an active dermatology residency program offer patients consults from board-certified dermatologists,” Dr. Benjamin Kaffenberger of Ohio State University Wexner Medical Center in Columbus tells Reuters Health.
“Before our study, there were numerous studies showing the value of dermatologists in the hospital setting in terms of changing diagnoses and treatment plans,” he says. “There were not any studies to show a benefit in metrics that are generally used to show patient or health system value.”
“For example,” he explains, “if a dermatologist changes a patient’s diagnosis from a skin infection, [such as] cellulitis, to allergic contact dermatitis, the hospital and even the patient may not care about that diagnosis change if [they] spend three days in the hospital either way and still has a 5% risk of readmission.”
“However, our study demonstrated a decreased readmission rate for patients and a decrease in the adjusted length of stay when board-certified dermatologists saw patients in our health system for a wide variety of acute and chronic rashes,” Dr. Kaffenberger says.
As reported in JAMA Dermatology, online on March 15, Dr. Kaffenberger and colleagues analyzed data from 413 patients with an inflammatory skin condition discharge diagnosis (61% women; mean age: 55) and 647 patients (50% women; mean age: 58) with an inflammatory skin condition admission diagnosis.1
Data from patients with a discharge diagnosis—primarily cellulitis, systemic lupus erythematosus and dermatitis due to medications—were used to calculate readmissions. Data from those with an admission diagnosis – mainly edema, cellulitis or rash – were used to calculate length of stay. All patients were hospitalized at the Wexner Medical Center between 2012 and 2014.
Dermatology consultations were associated with a reduction in one-year inflammatory skin condition readmissions among those who were discharged primarily with that condition (readmission probability, 0.0025 with a dermatology consultation versus 0.026 without the consultation; odds ratio, 0.093; P=0.03).
Dermatology consultations also were associated with a reduction of 2.64 days in the adjusted hospital length of stay (P<0.001).
“Patients are covered for consults as long as their hospital system and consulting dermatologists are within network, but most hospitals will not be able to offer dermatology consults,” Dr. Kaffenberger acknowledges. “I think the way of the future to provide broad access will be teledermatology within the hospital setting.”
“We are working on increasing Medicare/Medicaid coverage nationwide for this service,” he adds, “but there are already studies that demonstrate efficient triage and management of patients with skin disease using photos and standardized questionnaires with outpatient dermatologists.”
Dr. Delphine Lee, a dermatologist at Providence Saint John’s Health Center in Santa Monica, Calif., tells Reuters Health, “It is nice to see an effort to investigate the utility of having a dermatologist consultation for patients admitted to the hospital for inflammatory skin conditions.”
“In my experience, we often find dermatological conditions misdiagnosed by non-dermatologists, and this study confirms that consultations by dermatologists often result in changes in both diagnosis and treatment of hospitalized patients, resulting in a shorter stay,” she says.
“[It also] suggests utilizing a dermatologist for hospitalized patients with inflammatory skin diseases would have impact on utilization of healthcare resources—very relevant in this environment when everyone is trying to cut costs,” Dr. Lee concludes.
- Milani-Nejad N, Zhang M, Kaffenberger BH. Association of dermatology consultations with patient care outcomes in hospitalized patients with inflammatory skin diseases. JAMA Dermatol. 2017 Mar 15. doi: 10.1001/jamadermatol.2016.6130. [Epub ahead of print]