Impact of a Pediatric Dermatology Service on Emergency Department Utilization for Children with Dermatitis.
BACKGROUND
Atopic dermatitis (AD) is the most common chronic pediatric skin disease, and it can profoundly affect a family's quality of life. Children with flaring AD often seek treatment in emergency departments (EDs), which leads to expensive care and ineffective long-term disease control.


OBJECTIVE
The objective of the current study was to determine the effect of a pediatric dermatology service (PDS) on ED use and charges and of disease outcomes for patients diagnosed with AD before and after establishing an intramural PDS.


METHODS
This retrospective study reviewed electronic medical records of patients presenting to an urban children's hospital ED with diagnoses encompassing the terms AD, eczema, dermatitis and International Classification of Diseases, Ninth Revision (ICD-9) codes 691.8 and 692.9 during the year before (pre-PDS period) and 3 years after establishing a PDS.


RESULTS
There were 205 ED visits for dermatitis in the pre-PDS period and 130 in the with-PDS period, a 36.6% decrease (p < 0.001). In the pre-PDS period, 53.7% (n = 110/205) of patients presenting to the ED had moderate dermatitis, compared with 26.2% (n = 34/130) in the with-PDS period, a 69.1% decrease (p < 0.001). Total ED charges were $142,885 for the pre-PDS period and $90,610 for the with-PDS period, a $52,275 decrease.


CONCLUSIONS
This study provides a salient example of achieving the triple aim of health care reform: improving health outcomes (decreased ED visits) improving the patient experience (transitioning care from the ED to the more appropriate ambulatory clinical setting), and decreasing the cost of care (decreased ED charges).
School of Medicine, Saint Louis University, St. Louis, Missouri.
Brandon T
BT
Beal
Private Practice, Redondo Beach, California.
Edward
E
Prodanovic
Kaiser Permanente, Sacramento, California.
Jimmy E
JE
Kuo
School of Medicine, Saint Louis University, St. Louis, Missouri.|University Center for Outcomes Research, Saint Louis University, St. Louis, Missouri.
Eric S
ES
Armbrecht
School of Medicine, Saint Louis University, St. Louis, Missouri.|Cardinal Glennon Children's Medical Center, St. Louis, Missouri.
John R
JR
Peter
School of Medicine, Saint Louis University, St. Louis, Missouri.|Cardinal Glennon Children's Medical Center, St. Louis, Missouri.
Elaine C
EC
Siegfried
D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000453:epidemiology*; D003880:Dermatology / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D012189:Retrospective Studies