Inpatient Dermatology Services Linked to Improved Mortality, Readmission Rates

Benjamin Pollock, PhD

A new investigation into the benefits of inpatient dermatology found that these services were associated with improvements in mortality and readmissions rates for patients admitted for skin diseases.

The findings were presented at the American Academy of Dermatology (AAD) 2022 Annual Meeting in Boston.

With cutaneous disorders affecting up to 12% of all hospitalized adults in the US and accounting for $5 billion in annual health expenditures, the value of inpatient dermatology has only increased.

Investigators noted that single institution studies have suggested that inpatient dermatology services not only improve diagnostic accuracy but reduce readmissions.

However, the implications of these services on the broader healthcare system were uncertain, which prompted a team led by Benjamin Pollock, PhD, Department of Health Sciences Research at the Mayo Clinic, to compare mortality and readmission rates, length of stay (LOS), and cost at Society of Dermatology Hospitalists (SODH) hospitals versus non-member hospitals.

The team used a 100% sample from the 2016-2018 Center for Medicare & Medicaid Services (CMS) Inpatient Standard Analytic File and Master Beneficiary Summary File.

This data included all-dermatology specific discharges – 30,900 in total- from a total of 1912 US teaching hospitals.

From there, membership in the SODH was used to classify hospitals with inpatient dermatology services.

Encounter-level characteristics were compared between SODH and non-SODH members, and Elixhauser comorbidity indices for mortality and readmissions were calculated. Investigators also evaluated 30-day mortality, 30-day readmission, LOS, and cost differences across SODH and non-SODH hospitals.

In order to assess the risk-adjusted effect of SODH membership, a mixed effect logistic regression modeling was used to adjust for patient level characteristics such as Elixhauser Comorbidity Index, sex, and race, and hospital-level characteristics (bed size, for-profit status, geographic region) with a hospital-specific random effect.

Following risk adjustment, investigators observed that encounters at SODH hospitals experienced significantly lower 30-day mortality (OR=0.76; 95%CI: 0.60,0.97) (P=0.03) and 30-day readmissions (OR=0.88; 95%CI: 0.78,1.00) (P=0.05).

Mechanisms resulting in lower mortality and readmissions at SODH hospitals remained unclear. Additionally, though no differences were recorded regarding LOS, the average cost of hospitalization was $850 higher at SODH hospitals.

“In conclusion, these results suggest inpatient dermatology services, on a national level, are associated with risk-adjusted improvements in mortality and readmissions rates for patients admitted with skin diseases,” the team wrote.