title: Hospitalization for severe skin disease improves quality of life in the United Kingdom and the United States: a comparative study.
abstract: BACKGROUND
  Financial and managerial constraints have resulted in the rationalization of dermatology inpatient services in the United Kingdom and the United States. Therapeutic regimes may vary locally, regionally, and internationally but the clinical outcome of treatment remains the same.
  
  
  OBJECTIVE
  We studied 2 inpatient units: the University of Wales College of Medicine, Cardiff, United Kingdom, and the University of Miami School of Medicine, Miami, Florida, to compare the use and effectiveness of the service provided.
  
  
  METHODS
  Data were collected prospectively from inpatients during a 12-month period. The Dermatology Life Quality Index was administered on admission and after discharge. Data were recorded about the diagnosis, duration of admission, and referring dermatologist.
  
  
  RESULTS
  In all, 295 patients (Cardiff, UK) and 366 patients (Miami, Fla) participated. The average duration of admission in Miami was 6.7 days compared with 14.2 (P <.0001) in Cardiff. In Miami, the most common reasons necessitating admission were extensive disease (54%), the patient being unwell (18%), photophoresis (14%), outpatient treatment failure (8%), and acute deterioration of disease (4%). In Cardiff, the common reasons were acute deterioration (35%), extensive disease (28%), outpatient treatment failure (22%), and liver biopsy (4%). The most common diagnoses in Cardiff were psoriasis (31%) and eczema (26%). In contrast, the most common diagnoses in Miami, were psoriasis (19%), leg ulcers (17%), and mycosis fungoides (14%). The mean Dermatology Life Quality Index value for all patients decreased after admission in Cardiff (14.9-8.2, P <.0001) and Miami (12.0-8.5, P <.0001).
  
  
  CONCLUSIONS
  Despite the differences in the 2 health care systems, inpatient therapy remains an important and effective therapeutic option in the United States and the United Kingdom.
authors.affiliation: Department of Dermatology at University of Wales College of Medicine, Heath Park, United Kingdom.
authors.forename: R Sowjanya
authors.initials: RS
authors.lastname: Ayyalaraju
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Finlay
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dykes
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Trent
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Kerdel
mesh_terms: D003695:Delivery of Health Care; D003880:Dermatology; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data*; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D012871:Skin Diseases / Q000175:diagnosis / Q000628:therapy*; D006113:United Kingdom; D014481:United States