Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
J Gen Intern Med. 2013 Nov;28(11):1477-82. doi: 10.1007/s11606-013-2440-2. Epub 2013 May 25.
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.
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.
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.
Dermatology DRG admission and consult rates. For consults, frequency of dermatologic procedures performed, treatment recommendations made, changes in diagnoses, and readmissions.
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.
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.
近年来，皮肤科住院患者数量以及医疗保险针对皮肤科特定和皮肤科相关诊断相关分组（DRG）的支出不断增加，因此对皮肤科住院患者的研究显得尤为重要。然而，针对因皮肤疾病住院患者的住院研究主要集中在皮肤科会诊上，而忽略了未接受皮肤科会诊患者的就诊体验。根据 DRG 代码识别患者包括所有因皮肤疾病入院的患者，因此可以更全面地分析提供的皮肤科护理。
我们的主要目的是使用皮肤科 DRG 来描述所有因皮肤相关疾病入院患者的护理情况。我们的次要目的是评估为那些需要会诊的患者提供皮肤科会诊的效果。
我们对 2009 财年在波士顿一家学术医疗中心接受皮肤科特定或皮肤科相关 DRG 治疗的 512 名住院患者进行了回顾性病历审查。比较了有和没有皮肤科会诊的患者。
皮肤科 DRG 入院率和会诊率。对于会诊，评估皮肤科操作的频率、治疗建议、诊断变化和再入院率。
在皮肤科特定 DRG 病例中，有 51%的患者接受了皮肤科会诊，在皮肤科相关 DRG 病例中，有 3%的患者接受了皮肤科会诊。皮肤科会诊主要针对药物疹和蜂窝织炎等常见皮肤病；在所有蜂窝织炎患者中，有 5%的患者接受了皮肤科会诊。最常进行的干预措施包括皮肤活检、局部皮质类固醇推荐和皮肤护理方面的护理教育。皮肤科会诊改变了 45%的病例的诊断。
对于皮肤科相关 DRG 的患者，皮肤科医生通常不会参与治疗。当皮肤科医生参与会诊时，我们发现会诊对诊断和管理都有影响。
