Milani-Nejad Nima, Zhang Myron, Kaffenberger Benjamin H
Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus.
College of Medicine, Ohio State University Wexner Medical Center, Columbus.
JAMA Dermatol. 2017 Jun 1;153(6):523-528. doi: 10.1001/jamadermatol.2016.6130.
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.
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.
Hospital length of stay and 1-year readmission with inflammatory skin conditions.
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).
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.
传统上，住院皮肤科会诊的价值通过诊断和管理变化的频率来体现；然而，皮肤科会诊对诸如住院时间和再入院率等指标的影响仍不明确。
使用客观数据确定住院患者中皮肤科会诊与患者护理之间的关联。
设计、设置和参与者：我们回顾性查询了一所大学医学中心在2012年1月1日至2014年12月31日期间住院患者的去识别数据库。共选择了413例以原发性炎症性皮肤病出院诊断的患者和647例以原发性炎症性皮肤病入院诊断的患者。
住院时间和炎症性皮肤病的1年再入院情况。
413例以原发性炎症性皮肤病出院诊断的患者中，女性占61.0%，平均（标准差）年龄为55.1（16.4）岁。647例以原发性炎症性皮肤病入院诊断的患者中，女性占50.8%，平均（标准差）年龄为57.8（15.9）岁。多变量模型显示，皮肤科会诊与主要因炎症性皮肤病出院患者的1年炎症性皮肤病再入院率降低相关（再入院概率，0.0025；95%可信区间，0.00020 - 0.030，有皮肤科会诊；vs 0.026；95%可信区间，0.0065 - 0.10，无；比值比，0.093；95%可信区间，0.010 - 0.840；P = 0.03）。没有其他混杂变量与再入院率降低相关。多变量模型还显示，皮肤科会诊与调整后的住院时间缩短2.64天相关（95%可信区间，1.75 - 3.53天；P < 0.001）。
皮肤科会诊与住院患者结局改善相关。扩大皮肤科会诊服务的作用可能以具有成本效益的方式改善患者护理。
