Anna Yasmine Kirkorian, MD, and Justin Arnold, MMSc, on Reducing Hospital Readmissions for Skin Disease
A retrospective cohort study that was awarded an honorable mention at the 2018 American Academy of Dermatology Annual Meeting found that a number of significant healthcare and demographic disparities play a role in hospital readmissions for skin disease.
The study, which was published in the October 2018 issue of the Journal of the American Academy of Dermatology, pulled data from the 2014 Nationwide Readmissions Database in order to further characterize dermatology-related hospitalizations.
Ultimately, the data demonstrated that readmissions following dermatologic hospitalizations cost the American healthcare system $1.05 billion in 2014, with a 30-day readmission rate of 12.63% among the 647,251 weighted index admissions for skin disease assessed in the study.
Hospital readmissions were most common among patients with cutaneous lymphomas (39.63%), followed by connective tissue disorders (26.28%) and cutaneous congenital abnormalities (23.86%).
The factors that were most highly associated with readmission included:
- Being insured through Medicaid (odds ratio [OR] 1.61) or Medicare (OR 1.55)
- Living in a low-income community (OR 1.14)
- Having more chronic conditions (OR 4.46)
- Admission to a large hospital (OR 1.10)
Consultant360 spoke with lead author Anna Yasmine Kirkorian, MD, and first author Justin Arnold, MMSc, from the Department of Dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC, about these findings and their clinical implications.
Consultant360: How did this study come about? What compelled you to study hospital readmission rates among patients with skin disease?
Authors: This study came about from our interest in inpatient dermatology, which is an under-recognized but extremely important specialty within dermatology. Many skin conditions necessitate hospitalization, but it was unclear which conditions or patient demographics predispose individuals to poor outcomes such as hospital readmissions.
Re-hospitalizations are thought to reflect poor quality and inadequate care coordination, and in order to prevent these unnecessary hospitalizations, we sought to characterize hospital readmissions for patients admitted primarily for dermatologic conditions.
C360: Your study indicated that readmissions were most common in patients who were initially hospitalized with cutaneous lymphomas, connective tissue disorders, and cutaneous congenital abnormalities. Why do you think this was the case?
Authors: These conditions reflect some of the most difficult and recalcitrant diseases to treat within dermatology. Treatment challenges combined with the systemic manifestations of these skin conditions, likely predispose these individuals to requiring readmission to the hospital.
C360: What would you say was the most concerning finding from your study?
Authors: The most concerning finding from our study was that socioeconomic factors are large contributors to poor outcomes, such as hospital readmissions, in dermatology. We found that patients with public forms of insurance or those who resided in low income communities were more likely to readmitted than those with private insurance, or those who resided in wealthier communities, respectively.
Our findings emphasize the importance of addressing the underlying social and economic factors that affect medical outcomes, and therefore, national healthcare spending.
C360: In your view, how should the results of your study inform clinical practice? What steps should clinicians take to help reduce re-hospitalizations in patients with skin disease?
Authors: Clinicians should pay extra attention to discharge planning in patients with certain conditions, such as cutaneous lymphomas and connective tissue disorders, because these patients are most likely to require re-hospitalization. In order to reduce readmissions for individuals with skin disease, clinicians should advocate for expanding access to inpatient dermatology consultations, which have the potential to reduce unnecessary re-hospitalizations.
C360: What are the next steps in your research?
Authors: We next wish to assess how dermatology residency programs or inpatient dermatology consultations affect the likelihood of readmission following discharge from a hospitalization for skin disease.
Anna Yasmine Kirkorian, MD, is a board-certified dermatologist in the Division of Dermatology at Children’s National Health System in Washington, DC, and an assistant professor in the Department of Dermatology at the George Washington University School of Medicine & Health Sciences.
Justin Arnold, MMSc, is a researcher and medical student at the George Washington University School of Medicine & Health Sciences.
—Christina Vogt
Reference:
Arnold JD, Crockett R, Kirkorian AY. Hospital readmissions among patients with skin disease: A retrospective cohort study. J Am Acad Dermatol. 2018;79(4):696-701. https://doi.org/10.1016/j.jaad.2018.03.042