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Cuenca-Barrales C, de Vega-Martínez M, Descalzo-Gallego MÁ, García-Doval I. Stationäre Dermatologie: Wohin geht die Reise? Eine landesweite bevölkerungsbasierte Studie in Spanien von 2006 bis 2016. J Dtsch Dermatol Ges 2021; 19:707-719. [PMID: 33979051 DOI: 10.1111/ddg.14336_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos Cuenca-Barrales
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | - Marina de Vega-Martínez
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | | | - Ignacio García-Doval
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain.,Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Cuenca-Barrales C, de Vega-Martínez M, Descalzo-Gallego MÁ, García-Doval I. Inpatient dermatology: Where are we headed? A nationwide population-based study of Spain from 2006 to 2016. J Dtsch Dermatol Ges 2021; 19:707-717. [PMID: 33617112 DOI: 10.1111/ddg.14336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/04/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Information about hospital admissions for skin diseases is restricted to studies describing admissions to single centers, to specific wards, or only for a few diagnoses, and there is no information about the outcomes between different wards. The aim of this research is to describe hospital admissions due to dermatological diseases. PATIENTS AND METHODS Cross-sectional study of hospital discharges at Spanish hospitals. Discharges were assumed to be the same as admissions. RESULTS 519,440 discharges (1.1 % of total discharges) were identified. Most admissions (60.1 %) were done from emergency departments. Only 7 % of cases were admitted to dermatology wards. The most prevalent group was cellulitis and acute lymphangitis. Median age was 57 years, and men were more common. The median length of hospital stay was four days; 40,823 (7.9 %) cases required readmission. There were 13,558 (2.6 %) hospital deaths. After adjusted analysis (by age, sex and group of diagnosis), the OR of readmission was 1.49 (95 % CI: 1.42-1.57) times higher and length of stay was 0.22 (95 % CI: 0.15-0.29) days longer in non-dermatology wards (P < 0.0001). From 2006-2016, admissions to dermatology wards decreased 38 %, while in non-dermatology wards they increased 8 %. CONCLUSIONS A non-negligible number of patients require dermatological inpatient management. This is mainly provided by non-dermatologists. Some of our findings may indicate an improved overall care by dermatologists.
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Affiliation(s)
- Carlos Cuenca-Barrales
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | - Marina de Vega-Martínez
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | | | - Ignacio García-Doval
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain.,Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
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3
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Zhang M, Markova A, Harp J, Dusza S, Rosenbach M, Kaffenberger BH. Dermatology-specific and all-cause 30-day and calendar-year readmissions and costs for dermatologic diseases from 2010 to 2014. J Am Acad Dermatol 2019; 81:740-748. [PMID: 31102603 PMCID: PMC6698216 DOI: 10.1016/j.jaad.2019.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/14/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Readmissions for skin disease, particularly for the same diagnosis and over time, have not been well studied. OBJECTIVE To characterize hospital readmissions for skin disease. METHODS A cross-sectional observational study examined the Nationwide Readmissions Database from 2010 to 2014, a national sample of hospital discharges in the United States. RESULTS Of the patients in 3,602,599 dermatologic hospitalizations from 2010 to 2014, 9.8% were readmitted for any cause, 3.3% were admitted for the same diagnosis within 30 days, and 7.8% were readmitted for the same diagnosis within the calendar year (CY). The cost of all CY same-cause readmissions was $508 million per year. Mycosis fungoides had the highest 30-day all-cause readmission rate (32%), vascular hamartomas and dermatomyositis had the highest 30-day same-cause readmission rates (21% and 18%, respectively), and dermatomyositis and systemic lupus erythematosus had the highest CY same-cause readmission rates (31% and 24%, respectively). Readmission rates stayed stable from 2010 to 2014. Readmission for the same diagnosis was strongly associated with Medicaid and morbid obesity. LIMITATIONS This study is a broad description of hospitalizations for skin disease. Conclusions for individual diseases are not intended. CONCLUSION The rates and costs of readmissions for skin diseases remained high from 2010 to 2014. This study identifies diseases associated with high risk of hospital readmission, but disease-specific studies are needed. The diseases and risk factors presented should guide additional studies focused on strategies to reduce readmissions in specific skin diseases.
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Affiliation(s)
- Myron Zhang
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
| | - Alina Markova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Stephen Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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4
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Pelloni L, Cazzaniga S, Naldi L, Borradori L, Mainetti C. Emergency Consultations in Dermatology in a Secondary Referral Hospital in Southern Switzerland: A Prospective Cross-Sectional Analysis. Dermatology 2019; 235:243-249. [PMID: 30921799 DOI: 10.1159/000498850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The spectrum of dermatological emergencies is broad. Only a few studies have assessed the profile of dermatological conditions resulting in an emergency visit in a referral hospital. We sought to assess the conditions prompting an urgent dermatological visit and to compare the diagnoses with those made during the regular scheduled encounters. METHODS We performed a cross-sectional study of all patients with a cutaneous problem attending our emergency consultation during a 7-month period. The study variables were gender, age, duration of symptoms, diagnosis, need for hospitalization and/or follow-up. We further evaluated patients attending scheduled visits to compare the demographic characteristics and diagnoses between the two groups. RESULTS Six hundred fifty-two consecutive patients with an urgent dermatological consultation were included. Three hundred sixty (55.2%) were women and 292 (44.8%) were men. Infectious diseases (32.8%) as well as various forms of eczema (24.8%) constituted the most frequent causes for an emergency visit. Approximately 40% of emergency visits took place more than 1 week after the development of the cutaneous manifestations. The most frequent disorders seen in the 1,738 control patients included benign melanocytic and nonmelanocytic tumors (27.2%) and malignant skin lesions (11.5%). CONCLUSIONS Our study indicates that the dermatological diagnoses in the emergency visits significantly differ from those of the routinely scheduled appointments. In a significant portion of patients, the use of an emergency consultation was not justified. This study provides support to the idea that a specific training is required to manage dermatological emergencies and that efforts should be made to reduce unjustified emergency visit use.
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Affiliation(s)
- Lorenzo Pelloni
- Dermatology Department, Ente Ospedaliero Cantonale, Regional Hospital of Bellinzona e Valli, Bellinzona, Switzerland, .,Department of Dermatology, University Hospital of Bern, Inselspital, Bern, Switzerland,
| | - Simone Cazzaniga
- Department of Dermatology, University Hospital of Bern, Inselspital, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | | | - Luca Borradori
- Department of Dermatology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Carlo Mainetti
- Dermatology Department, Ente Ospedaliero Cantonale, Regional Hospital of Bellinzona e Valli, Bellinzona, Switzerland
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5
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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; 153:523-528. [PMID: 28296992 DOI: 10.1001/jamadermatol.2016.6130] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The value of inpatient dermatology consultations has traditionally been demonstrated with frequency in changes of diagnosis and management; however, the impact of dermatology consultations on metrics such as hospital length of stay and readmission rates remains unknown. Objective To determine the association of dermatology consultations with patient care in hospitalized patients using objective values. Design, Setting, and Participants We retrospectively queried the deidentified database of patients hospitalized between January 1, 2012, and December 31, 2014, at a single university medical center. A total of 413 patients with a primary inflammatory skin condition discharge diagnosis and 647 patients with primary inflammatory skin condition admission diagnosis were selected. Main Outcomes and Measures Hospital length of stay and 1-year readmission with inflammatory skin conditions. Results The 413 patients with a primary inflammatory skin condition discharge diagnosis were 61.0% female and had a mean (SD) age of 55.1 (16.4) years. The 647 patients with primary inflammatory skin condition admission diagnosis were 50.8% female and had a mean (SD) age of 57.8 (15.9) years. Multivariable modeling showed that dermatology consultations were associated with a reduction of 1-year inflammatory skin condition readmissions among patients who were discharged primarily with an inflammatory skin condition (readmission probability, 0.0025; 95% CI, 0.00020-0.030 with dermatology consult vs 0.026; 95% CI, 0.0065-0.10 without; odds ratio, 0.093; 95% CI, 0.010-0.840; P = .03). No other confounding variable was associated with reduction in readmissions. Multivariable modeling also showed that dermatology consultations were associated with a reduction in the adjusted hospital length of stay by 2.64 days (95% CI, 1.75-3.53 days; P < .001). Conclusions and Relevance Dermatology consultations were associated with improvements of outcomes among hospitalized patients. The expansion of the role of dermatology consultation services may improve patient care in a cost-effective manner.
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Affiliation(s)
- Nima Milani-Nejad
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Myron Zhang
- College of Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus
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Hospitalization of Dermatologic Patients: Why, When, and Where? ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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7
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Martínez-Morán C, Borbujo J. Hospitalización del paciente dermatológico, ¿dónde, cuándo y por qué? ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:395-399. [DOI: 10.1016/j.ad.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/18/2017] [Accepted: 01/30/2017] [Indexed: 11/26/2022] Open
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Abstract
Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information.
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Affiliation(s)
- Lauren K Biesbroeck
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street BB-1353, Box 356524, Seattle, WA 98195-6524, USA
| | - Michi M Shinohara
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street BB-1353, Box 356524, Seattle, WA 98195-6524, USA.
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Rubegni P, Cevenini G, Lamberti A, Bruni F, Tiezzi R, Verzuri A, Barbini P, Manzi P, Fimiani M. Dermatological conditions presenting at the Emergency Department in Siena University Hospital from 2006 to 2011. J Eur Acad Dermatol Venereol 2014; 29:164-8. [PMID: 24754355 DOI: 10.1111/jdv.12513] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 03/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Published studies on emergency dermatology consultations are few because there are few dermatology emergency units in the world. No study has yet described the Italian situation. OBJECTIVES To quantify and characterize patients evaluated in our dermatology emergency unit from 2006 to 2011. METHODS We studied personal details, diagnosis, annual trend of cases, emergency level and hospitalization of dermatology cases over the 6-year period. RESULTS A total of 12,226 patients were evaluated. The most numerous diagnostic group was infections (27.1%), followed by non-specific and descriptive diagnosis (22.5%), skin conditions caused by mechanical or physical agents (13.1%), eczematous diseases (10.5%), insect bites (9.5%) and urticaria/angio-oedema (8.8%). The most common indications for admission to hospital were skin conditions caused by mechanical or physical agents (33.3%), infections (27.5%), drug eruption (15.9%) and autoimmune or inflammatory disorders (7.4%). Emergency dermatology cases followed a variable annual trend, with more consultations in the summer months. CONCLUSION This is the first long-term retrospective analysis of a large series of dermatology emergency patients. It provides useful quantitative and qualitative information on cases for physicians and the national health system for the purposes of improving patient care and cost-effectiveness.
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Affiliation(s)
- P Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, Siena University Hospital, Siena, Italy
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10
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Hu L, Haynes H, Ferrazza D, Kupper T, Qureshi A. Impact of specialist consultations on inpatient admissions for dermatology-specific and related DRGs. J Gen Intern Med 2013; 28:1477-82. [PMID: 23709404 PMCID: PMC3797349 DOI: 10.1007/s11606-013-2440-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 01/31/2013] [Accepted: 03/20/2013] [Indexed: 11/27/2022]
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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Affiliation(s)
- Lissy Hu
- />Harvard Medical School, Brigham and Women’s Hospital, Boston, MA USA
| | - Harley Haynes
- />Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Dawn Ferrazza
- />Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Thomas Kupper
- />Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - Abrar Qureshi
- />Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
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11
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Dawe RS. Reduced dermatology hospital bed numbers in Scotland: where do patients go? Clin Exp Dermatol 2012; 37:189-90. [DOI: 10.1111/j.1365-2230.2011.04132.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Ahn C, Davis SA, Dabade TS, Fleischer AB, Feldman SR. Services Available and Their Effectiveness. Dermatol Clin 2012; 30:19-37, vii. [DOI: 10.1016/j.det.2011.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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13
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Analysis of inpatient dermatologic referrals: insight into the educational needs of trainee doctors. Ir J Med Sci 2008; 178:69-71. [PMID: 19002549 DOI: 10.1007/s11845-008-0251-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
Abstract
AIM To analyse inpatient consultation referrals to the Dermatology Department and to identify the educational needs of junior/trainee doctors. METHODS Consultation data of inpatients referred to the Dermatology Department between 2001 and 2006 was reviewed. RESULTS There were 703 referrals identified. Patients were referred from all wards in the hospital. There were a total of 113 different dermatological diagnoses in the group. One-fifth (22%) consultations were for skin infections, 12% had atopic dermatitis, 8% had psoriasis and 8% had clear or suspected drug cause for their rash. In 391 cases, the Consultant Dermatologist's diagnosis was different to the inpatient referral diagnosis on the consultation referral form. CONCLUSIONS Our results emphasise the need for junior dermatology trainees to undertake extra training in both the dermatologic conditions. This data supports the need for expansion of service provision of dermatology in the region.
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Hensen P, Beissert S, Bruckner-Tuderman L, Luger TA, Roeder N, Müller ML. Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting. Eur J Public Health 2007; 18:85-91. [PMID: 17569699 DOI: 10.1093/eurpub/ckm059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND German diagnosis-related groups (G-DRG) have been introduced in Germany as a reimbursement system for in-patient care. The aim of this study was to report data-based experiences from the introduction process and to evaluate the impact on in-patient dermatology. METHODS A quantitative analysis including clinical data from two large university centres of dermatology over a time period of 4 years (2003-06) has been performed. Characteristics and trends of case-mix index, number of cases, average age, length of stay (LOS), surgical and medical treatments and in-patient case groups were studied in detail. RESULTS It was found that the case-mix index values increased after the introduction period, but subsequently declined on the initial value. At the same time, an increase of dermatological hospital admissions can be noticed parallel to a significant reduction of LOS (P < 0.001) and a moderate increase of average age (P < 0.001). Analysis of DRG assignment revealed an initial significant decline of surgical in-patient procedures and increasing medical treatments, however, without obvious long-term changes. Furthermore, a growing importance for dermatological oncology and inflammable skin diseases within the in-patient setting could be observed. CONCLUSIONS The introduction of the G-DRG system in Germany induced changes in in-patient care affecting hospital admission rates, LOS and cases treated in an in-patient setting. In-patient activities have not been reduced with the DRG introduction; however, long-term interdisciplinary research approaches are needed to explore the future impact on health care providing and quality of health care in depth.
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Affiliation(s)
- P Hensen
- Department of Dermatology, Medical Management, University of Münster, D-48149 Münster, Germany.
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15
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Hensen P, Fürstenberg T, Luger TA, Steinhoff M, Roeder N. Case mix measures and diagnosis-related groups: opportunities and threats for inpatient dermatology. J Eur Acad Dermatol Venereol 2006; 19:582-8. [PMID: 16164713 DOI: 10.1111/j.1468-3083.2005.01258.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The changing healthcare environment world-wide is leading to extensive use of per case payment systems based on diagnosis-related groups (DRG). The aim of this study was to examine the impact of application of different DRG systems used in the German healthcare system. METHODS We retrospectively analysed 2334 clinical data sets of inpatients discharged from an academic dermatological inpatient unit in 2003. Data were regarded as providing high coding quality in compliance with the diagnosis and procedure classifications as well as coding standards. The application of the Australian AR-DRG version 4.1, the German G-DRG version 1.0, and the German G-DRG version 2004 was considered in detail. To evaluate more specific aspects, data were broken down into 11 groups based on the principle diagnosis. MAIN OUTCOME MEASURE DRG cost weights and case mix index were used to compare coverage of inpatient dermatological services. Economic impacts were illustrated by case mix volumes and calculation of DRG payments. RESULTS Case mix index results and the pending prospective revenues vary tremendously from the application of one or another of the DRG systems. The G-DRG version 2004 provides increased levels of case mix index that encourages, in particular, medical dermatology. CONCLUSIONS The AR-DRG version 4.1 and the first German DRG version 1.0 appear to be less suitable to adequately cover inpatient dermatology. The G-DRG version 2004 has been greatly improved, probably due to proceeding calculation standards and DRG adjustments. The future of inpatient dermatology is subject to appropriate depiction of well-established treatment standards.
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Affiliation(s)
- P Hensen
- Department of Dermatology, University of Muenster, Muenster, Germany
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García-Doval I, Feal C, Rosón E, de la Torre C, Abalde MT, Flórez A, Cruces MJ. Inpatient dermatology: characteristics of patients and admissions in a Spanish hospital. J Eur Acad Dermatol Venereol 2002; 16:334-8. [PMID: 12224688 DOI: 10.1046/j.1468-3083.2002.00473.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Inpatient dermatology has not been properly described in many countries. National differences might be important in the evaluation of its usefulness and the applicability of politics of health expenditure restrictions. OBJECTIVE To describe inpatient activity and readmission rates in a dermatology department in Spain. STUDY DESIGN Cross-sectional prospective study in a single hospital. SETTING Secondary care hospital of the National Health Service in Pontevedra (Spain). METHODS From May 1997 to December 2000, all discharge sheets (1048) were included in the study, codified and described. RESULTS Surgery was the reason for admission in 37% of the inpatients. The most frequent diagnosis were: neoplasm (36%), infection (15%), psoriasis (10%), other (10%), dermatitis (6%) and drug reaction (5%). Readmission rates were 1.8% within 30 days, and 12.5% within 1 year. CONCLUSIONS Inpatient dermatology is different in different countries. Compared with what has been described in the USA or UK, our data suggest an important surgical content of inpatient dermatology in Spain, not reported in those countries. Medical diagnoses also differ, consisting of more infections, and less psoriasis and dermatitis in our setting. Readmission rates are low when compared with previously published ones, a finding that supports a long-term benefit of hospitalization.
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Affiliation(s)
- I García-Doval
- Department of Dermatology, Complexo Hospitalario de Pontevedra, Spain.
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Kirsner RS, Yang DG, Kerdel FA. Inpatient dermatology. The difficulties, the reality, and the future. Dermatol Clin 2000; 18:383-90, vii. [PMID: 10943533 DOI: 10.1016/s0733-8635(05)70186-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Changes in the health care delivery system have profoundly affected medical dermatology in the United States. Although a significant number of patients are still being admitted for skin and skin-related disorders, only a minority are now admitted by dermatologists. An analysis of the mechanics of such a change and a national perspective is presented.
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Affiliation(s)
- R S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida, USA.
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Kirsner RS, Hannon W, Agarwal A, Kerdel FA. The effect of health care delivery systems on admission to and treatment at an inpatient dermatology unit. Dermatol Clin 2000; 18:391-5, vii. [PMID: 10943534 DOI: 10.1016/s0733-8635(05)70187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The University of Miami Department of Dermatology has maintained an active inpatient unit. Analysis of data from a 12 month period from 1995-1996 showed 562 admissions. Cutaneous lymphoma, psoriasis, and chronic wounds accounted for over half the admissions. Most patients were insured by a fee-for-service system, and compared to patients insured by managed care systems or patients who were indigent, fee-for-service patients had the shortest length of stay. Using a case mix severity index, indigent patients had the greatest disease severity followed by fee-for-service patients. Patients enrolled in managed care systems had the least severity suggesting that factors other than disease severity alone may play a role in determining why patients are admitted.
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Affiliation(s)
- R S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida, USA.
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Ayyalaraju RS, Finlay AY. Inpatient dermatology. United Kingdom and United States similarities: moving with the times or being relegated to the back bench? Dermatol Clin 2000; 18:397-404, vii-viii. [PMID: 10943535 DOI: 10.1016/s0733-8635(05)70188-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Financial and managerial pressures have resulted in the rationalization of inpatient dermatology beds in the United Kingdom. Although these two countries have different populations and health care systems, both have been subject to similar drives toward cost containment. Advances in dermatology have broadened the reach of outpatient-based dermatological care that provides for most skin patients; however, inpatient treatment remains an important and essential therapeutic option for a group of patients. Dermatologic inpatient care may be inadequately and inefficiently provided by nondermatologists. It is important to ensure that the quality of dermatology inpatient services is maintained at the highest standard while using, and working within, a constantly evolving system of health care. Only then can dermatologists tailor the specialty to maximize the benefits for the patients and the profession as a whole.
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Affiliation(s)
- R S Ayyalaraju
- Department of Dermatology, University of Wales College of Medicine, United Kingdom
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