Inpatient dermatologic therapy is linked to lower mortality and readmission rates

Inpatients treated for skin disorders fare better in hospitals that provide specialist dermatologic services. Although the resulting costs are moderately higher, the odds of mortality and re-admission are decreased.

In 2014, about 12% of adult patients who were hospitalised in the USA carried the diagnosis of a skin disorder and their in-hospital care was associated with costs of over 5 billion US dollars [1]. Single-centre data showed that dermatologic specialist consultations for inpatients entailed lower numbers of readmission and greater diagnostic precision [2,3].

A retrospective study using Centers for Medicare & Medicaid Services data strove to investigate whether inpatient dermatologic treatment led to superior outcomes [4]. Assessed were more than 30,900 dermatology patients with major and minor skin disorders discharged from 1,912 teaching hospitals in the USA from January 2016 to November 2018. The presence of inpatient dermatology was defined via hospital membership in the Society of Dermatology Hospitalists.

The files were evaluated for mortality and readmission within a window of 30 days, as well as expenditure and number of days in the hospital. A mixed logistic regression analysis controlled for factors including sex, comorbidity, race, Medicare Severity Diagnosis Related Groups, and indicators for the hospital level.

The results showed statistically significant lower likelihoods for all-cause mortality as well as readmissions in hospitals with inpatient dermatologic services. The 30-day mortality odds were 0.76 (95% CI 0.60–0.97; P=0.03). The corresponding results for 30-day readmission attributed odds of 0.88 (95% CI 0.78–1.00; P=0.05) in favour of inpatient dermatologic treatment. The investigators hypothesised that higher accuracy in diagnostics and therapy might be underlying this effect. However, differences in length of hospital stay were not significant. The additional costs for treatment in a hospital with a membership of the Society of Dermatology Hospitalists were estimated at 850 US dollars per claim. In light of the superior results regarding rates of mortality and readmission, the authors deemed this a modest cost difference.

 

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   1. Arnold JD, et al. J Am Acad Dermatol;80(2):425–432.
   2. Hu L, et al. J Gen Intern Med. 2013;28(11):1477–1482.
   3. Milani-Nejad N, et al. JAMA Dermatol. 2017;153(6):523–528.
   4. Puri P, et al. Inpatient dermatology services are associated with lower mortality and readmissions rates: a nationally representative analysis of 30,900 hospitalizations. P33931, AAD 2022 Annual Meeting, 25–29 March, Boston, MA, USA.

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Posted on 18 May, 202223 May, 2022