[Characteristics of patients admitted to a Division of Internal Medicine. Is hospital the best setting of care?].

Abstract

The aim of this study was to describe the characteristics of institutionalized patients, the patterns of admission, hospital stay and discharge and the extent of resource utilization before, during and after hospitalization, in an Acute Division of Internal Medicine of a university hospital. All adult patients admitted to the division were consecutively enrolled during a 3-month study period. Patients underwent a multidimensional assessment and data collection concerning admission and discharge patterns, resource utilization, and discharge diagnosis. Three hundred and eighteen patients, with an average age of 73.8 years, entered in the study; the rate of patients both affected by severe cognitive and functional impairment was high (29.9%); 3-4 comorbidity classes were estimated in 70.8% of patients; the most frequent diagnoses at discharge were gastrointestinal (major diagnostic category 6), liver and pancreas diseases (major diagnostic category 7); despite the high rate of comorbidity and severity of illness, the average diagnosis-related groups was low (1.15 +/- 0.59) and also the levels of nursing and personal care provided in the hospital were low (21 +/- 15 and 19 +/- 16, respectively). Median length of stay was 9 days and 3-4 comorbidity classes significantly prolonged hospitalization (p < 0.01). The main critical aspects concerning hospital admissions were the low rates of general practitioner requests of admission (26.7%), the high rates of unplanned readmissions (17.9%) and inappropriate recovery (12.6%). Concerning discharge, only 18.5% of patients had assisted discharges despite the high rates of patients with functional impairment; difficulties at discharge were estimated in 15.0% of patients. Our data suggest to improve the relation between hospital and primary health services in order to assure appropriateness of patient care and optimal use of a specialistic division.