title: [Dermatology day-care: between official rules and reality].
abstract: BACKGROUND
  Official rules published in 2006 and 2010 concerning ambulatory care rates in France led to artificial redistribution of this activity from day-care hospitalization to consultations. In our dermatological day-care establishment, we compared the financial costs engendered for patients admitted for day-care hospitalization and those seen at consultations.
  
  
  METHODS
  From 2011/01/10 to 2011/02/04, for each patient, we prospectively analyzed the following data: day-care hospitalization or consultation, age, sex, diagnosis, laboratory and radiological examination, non-dermatological consultations, time spent with the patient by doctors (interns, senior doctors) and nurses, with timing by a stop-watch. The hospital cost was the total for medical examinations (official nomenclature), non-dermatological consultations, physicians' and nurses' salaries and establishment overheads (216 €). The hospital revenue regarding the consultation group consisted of the sum of reimbursement for medical examination, dermatological and non-dermatological consultations, and regarding the day-care hospitalization group, the dermatology rate (670 €) or chemotherapy sessions (380 €). Results were compared using a Chi(2) test and a Student's t-test (P ≤ 0.05).
  
  
  RESULTS
  One hundred and twenty-seven patients were included: 67 in the day-care hospitalization group and 60 in the consultation group. Patients in the day-care hospitalization group were older and had significantly more radiological examinations and non-dermatological consultations, but the number of laboratory examinations and skin biopsies did not differ between the two groups. The mean time spent by doctors was similar in both groups but the time spent by senior doctors without the help of interns was significantly greater and longer than the time for a standard consultation. Nurses spent a mean 72 minutes with each hospitalized patient and 35 minutes with consultation patients (P = 0.007). Hospital costs were identical in both groups at around 415 €. The hospital showed a profit for day-care hospitalization patients (252 €) and a loss (244 €) for consultation patients.
  
  
  CONCLUSIONS
  Half of the patients studied were in day-care hospitalization and half were seen in consultations. The high number of bed-ridden patients with bullous pemphigoid accounts for the fact that day-care patients were older. The reasons for the significantly longer time spent by nurses with day-care hospitalized patients were administration and supervision of chemotherapy, skin care and nursing of bed-ridden patients. However, nurses spent 35 min with each consultation patient, justifying the need to maintain the posts of these staff in such day-care units. The availability of physicians for patients with severe dermatoses and the organization of medical examinations in the same place in the same day underscore the need for medical structures like day-care hospitalization. At present, time spent on intellectual work involving reflection is regrettably not taken into account, which is detrimental to this specialty. The hospital was in profit for day hospitalizations while consultations resulted in losses, in particular because of the absence of social security reimbursement of the establishment's overheads.
  
  
  CONCLUSIONS
  Rules are in need of modification in order to allow the treatment of patients with more complicated conditions.
authors.affiliation: Service de dermatologie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France. saskia.oro@hmn.aphp.fr
authors.forename: S
authors.initials: S
authors.lastname: Ingen-Housz-Oro
authors.forename: I
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: A
authors.initials: A
authors.lastname: Cosnes
authors.forename: L
authors.initials: L
authors.lastname: Valeyrie-Allanore
authors.forename: J-C
authors.initials: JC
authors.lastname: Moreno
authors.forename: O
authors.initials: O
authors.lastname: Chosidow
authors.forename: P
authors.initials: P
authors.lastname: Wolkenstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003631:Day Care, Medical / Q000191:economics* / Q000458:organization & administration*; D003880:Dermatology / Q000191:economics* / Q000458:organization & administration*; D005260:Female; D005602:France; D017722:Hospital Charges / Q000458:organization & administration / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006748:Hospital Departments / Q000191:economics* / Q000458:organization & administration*; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000458:organization & administration*; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D011907:Rate Setting and Review / Q000458:organization & administration; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration; D012871:Skin Diseases / Q000175:diagnosis / Q000191:economics / Q000628:therapy*