title: Impact of specialist consultations on inpatient admissions for dermatology-specific and related DRGs.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Dermatology DRG admission and consult rates. For consults, frequency of dermatologic procedures performed, treatment recommendations made, changes in diagnoses, and readmissions.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Lissy
authors.initials: L
authors.lastname: Hu
authors.forename: Harley
authors.initials: H
authors.lastname: Haynes
authors.forename: Dawn
authors.initials: D
authors.lastname: Ferrazza
authors.forename: Thomas
authors.initials: T
authors.lastname: Kupper
authors.forename: Abrar
authors.initials: A
authors.lastname: Qureshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003880:Dermatology / Q000379:methods / Q000592:standards*; D003953:Diagnosis-Related Groups / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D013038:Specialization / Q000592:standards*; D055815:Young Adult