Inpatient management of psoriasis: a multicentre service review to establish national admission standards

A L Woods; K J Rutter; L S Gardner; V J Lewis; S Saxena; S A George; R J G Chalmers; C E M Griffiths; E L Speight; A V Anstey; L Ronda; D McGibbon; J W N Barker; C H Smith

doi:10.1111/j.1365-2133.2007.08338.x

Inpatient management of psoriasis: a multicentre service review to establish national admission standards

A L Woods, K J Rutter, L S Gardner, V J Lewis, S Saxena, S A George, R J G Chalmers, C E M Griffiths, E L Speight, A V Anstey, L Ronda, D McGibbon, J W N Barker, C H Smith

Division of Musculoskeletal & Dermatological Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Some patients with psoriasis may require hospital admission to stabilize their condition, although the role of inpatient management is changing given recent advances in therapeutic options, emphasis on community-based care for chronic conditions and limited healthcare resources. There is a need for evidence-based national standards for inpatient management of psoriasis taking account of factors that predict length of stay.

OBJECTIVES: To determine which factors predict length of stay for patients with psoriasis requiring inpatient hospital care with a view to setting evidence-based standards for inpatient psoriasis management.

METHODS: A multicentre service review was conducted on all psoriasis admissions over a 9-month period in four dermatology centres in the U.K. We collected data on admission, at discharge and, where possible, at 3 months following discharge. Psoriasis severity was assessed using four validated scoring systems, including Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index. We also recorded length of stay and treatment details.

RESULTS: Length of stay varied widely between the four centres, but was similar in the two centres which received a high proportion of tertiary referrals for severe psoriasis (mean 19.7 days, range 1-78, analysis of variance P=0.002). Disease severity, measured by PASI, on admission (mean 15.7, interquartile range 8.3-20.8) was significantly higher in the tertiary centres (P<0.0001). However, there was no significant difference in PASI between centres on discharge. The admission PASI was significantly associated with length of stay (r=0.2, P=0.02). There was no significant correlation between other measures of disease severity and length of stay.

CONCLUSIONS: Disease severity on admission for patients with psoriasis is greater in tertiary referral centres for psoriasis and is directly associated with length of stay. Length of stay should be used in conjunction with clinical measures such as PASI improvement to set national standards for quality in secondary care.

Original language	English
Pages (from-to)	266-272
Number of pages	7
Journal	British Journal of Dermatology
Volume	158
Issue number	2
DOIs	https://doi.org/10.1111/j.1365-2133.2007.08338.x https://doi.org/10.1111/j.1365-2133.2007.08338.x
Publication status	Published - 1 Feb 2008

Keywords

Analysis of Variance
Humans
Length of Stay/statistics & numerical data
Medical Records
Psoriasis/therapy
Quality of Life
Risk Factors
Severity of Illness Index
United Kingdom

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Woods, A. L., Rutter, K. J., Gardner, L. S., Lewis, V. J., Saxena, S., George, S. A., Chalmers, R. J. G., Griffiths, C. E. M., Speight, E. L., Anstey, A. V., Ronda, L., McGibbon, D., Barker, J. W. N., & Smith, C. H. (2008). Inpatient management of psoriasis: a multicentre service review to establish national admission standards. British Journal of Dermatology, 158(2), 266-272. https://doi.org/10.1111/j.1365-2133.2007.08338.x, https://doi.org/10.1111/j.1365-2133.2007.08338.x

@article{9572a69f8bce480e82d0675d0ae2224e,

title = "Inpatient management of psoriasis: a multicentre service review to establish national admission standards",

abstract = "BACKGROUND: Some patients with psoriasis may require hospital admission to stabilize their condition, although the role of inpatient management is changing given recent advances in therapeutic options, emphasis on community-based care for chronic conditions and limited healthcare resources. There is a need for evidence-based national standards for inpatient management of psoriasis taking account of factors that predict length of stay.OBJECTIVES: To determine which factors predict length of stay for patients with psoriasis requiring inpatient hospital care with a view to setting evidence-based standards for inpatient psoriasis management.METHODS: A multicentre service review was conducted on all psoriasis admissions over a 9-month period in four dermatology centres in the U.K. We collected data on admission, at discharge and, where possible, at 3 months following discharge. Psoriasis severity was assessed using four validated scoring systems, including Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index. We also recorded length of stay and treatment details.RESULTS: Length of stay varied widely between the four centres, but was similar in the two centres which received a high proportion of tertiary referrals for severe psoriasis (mean 19.7 days, range 1-78, analysis of variance P=0.002). Disease severity, measured by PASI, on admission (mean 15.7, interquartile range 8.3-20.8) was significantly higher in the tertiary centres (P<0.0001). However, there was no significant difference in PASI between centres on discharge. The admission PASI was significantly associated with length of stay (r=0.2, P=0.02). There was no significant correlation between other measures of disease severity and length of stay.CONCLUSIONS: Disease severity on admission for patients with psoriasis is greater in tertiary referral centres for psoriasis and is directly associated with length of stay. Length of stay should be used in conjunction with clinical measures such as PASI improvement to set national standards for quality in secondary care.",

keywords = "Analysis of Variance, Humans, Length of Stay/statistics & numerical data, Medical Records, Psoriasis/therapy, Quality of Life, Risk Factors, Severity of Illness Index, United Kingdom",

author = "Woods, {A L} and Rutter, {K J} and Gardner, {L S} and Lewis, {V J} and S Saxena and George, {S A} and Chalmers, {R J G} and Griffiths, {C E M} and Speight, {E L} and Anstey, {A V} and L Ronda and D McGibbon and Barker, {J W N} and Smith, {C H}",

year = "2008",

month = feb,

day = "1",

doi = "10.1111/j.1365-2133.2007.08338.x",

language = "English",

volume = "158",

pages = "266--272",

journal = "British Journal of Dermatology",

issn = "0007-0963",

publisher = "Oxford University Press",

number = "2",

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Woods, AL, Rutter, KJ, Gardner, LS, Lewis, VJ, Saxena, S, George, SA, Chalmers, RJG, Griffiths, CEM, Speight, EL, Anstey, AV, Ronda, L, McGibbon, D, Barker, JWN & Smith, CH 2008, 'Inpatient management of psoriasis: a multicentre service review to establish national admission standards', British Journal of Dermatology, vol. 158, no. 2, pp. 266-272. https://doi.org/10.1111/j.1365-2133.2007.08338.x, https://doi.org/10.1111/j.1365-2133.2007.08338.x

TY - JOUR

T1 - Inpatient management of psoriasis

T2 - a multicentre service review to establish national admission standards

AU - Woods, A L

AU - Rutter, K J

AU - Gardner, L S

AU - Lewis, V J

AU - Saxena, S

AU - George, S A

AU - Chalmers, R J G

AU - Griffiths, C E M

AU - Speight, E L

AU - Anstey, A V

AU - Ronda, L

AU - McGibbon, D

AU - Barker, J W N

AU - Smith, C H

PY - 2008/2/1

Y1 - 2008/2/1

N2 - BACKGROUND: Some patients with psoriasis may require hospital admission to stabilize their condition, although the role of inpatient management is changing given recent advances in therapeutic options, emphasis on community-based care for chronic conditions and limited healthcare resources. There is a need for evidence-based national standards for inpatient management of psoriasis taking account of factors that predict length of stay.OBJECTIVES: To determine which factors predict length of stay for patients with psoriasis requiring inpatient hospital care with a view to setting evidence-based standards for inpatient psoriasis management.METHODS: A multicentre service review was conducted on all psoriasis admissions over a 9-month period in four dermatology centres in the U.K. We collected data on admission, at discharge and, where possible, at 3 months following discharge. Psoriasis severity was assessed using four validated scoring systems, including Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index. We also recorded length of stay and treatment details.RESULTS: Length of stay varied widely between the four centres, but was similar in the two centres which received a high proportion of tertiary referrals for severe psoriasis (mean 19.7 days, range 1-78, analysis of variance P=0.002). Disease severity, measured by PASI, on admission (mean 15.7, interquartile range 8.3-20.8) was significantly higher in the tertiary centres (P<0.0001). However, there was no significant difference in PASI between centres on discharge. The admission PASI was significantly associated with length of stay (r=0.2, P=0.02). There was no significant correlation between other measures of disease severity and length of stay.CONCLUSIONS: Disease severity on admission for patients with psoriasis is greater in tertiary referral centres for psoriasis and is directly associated with length of stay. Length of stay should be used in conjunction with clinical measures such as PASI improvement to set national standards for quality in secondary care.

AB - BACKGROUND: Some patients with psoriasis may require hospital admission to stabilize their condition, although the role of inpatient management is changing given recent advances in therapeutic options, emphasis on community-based care for chronic conditions and limited healthcare resources. There is a need for evidence-based national standards for inpatient management of psoriasis taking account of factors that predict length of stay.OBJECTIVES: To determine which factors predict length of stay for patients with psoriasis requiring inpatient hospital care with a view to setting evidence-based standards for inpatient psoriasis management.METHODS: A multicentre service review was conducted on all psoriasis admissions over a 9-month period in four dermatology centres in the U.K. We collected data on admission, at discharge and, where possible, at 3 months following discharge. Psoriasis severity was assessed using four validated scoring systems, including Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index. We also recorded length of stay and treatment details.RESULTS: Length of stay varied widely between the four centres, but was similar in the two centres which received a high proportion of tertiary referrals for severe psoriasis (mean 19.7 days, range 1-78, analysis of variance P=0.002). Disease severity, measured by PASI, on admission (mean 15.7, interquartile range 8.3-20.8) was significantly higher in the tertiary centres (P<0.0001). However, there was no significant difference in PASI between centres on discharge. The admission PASI was significantly associated with length of stay (r=0.2, P=0.02). There was no significant correlation between other measures of disease severity and length of stay.CONCLUSIONS: Disease severity on admission for patients with psoriasis is greater in tertiary referral centres for psoriasis and is directly associated with length of stay. Length of stay should be used in conjunction with clinical measures such as PASI improvement to set national standards for quality in secondary care.

KW - Analysis of Variance

KW - Humans

KW - Length of Stay/statistics & numerical data

KW - Medical Records

KW - Psoriasis/therapy

KW - Quality of Life

KW - Risk Factors

KW - Severity of Illness Index

KW - United Kingdom

U2 - 10.1111/j.1365-2133.2007.08338.x

DO - 10.1111/j.1365-2133.2007.08338.x

M3 - Article

C2 - 18067482

SN - 0007-0963

VL - 158

SP - 266

EP - 272

JO - British Journal of Dermatology

JF - British Journal of Dermatology

IS - 2

ER -

Inpatient management of psoriasis: a multicentre service review to establish national admission standards

Abstract

Keywords

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