Gómez Joaquín, García-Vázquez Elisa, Antonio Puertas José, Ródenas Julio, Herrero José Antonio, Albaladejo Carmen, Baños Víctor, Canteras Manuel, Alcaraz Manolo
Servicio de Medicina Interna-Infecciosas, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
Enferm Infecc Microbiol Clin. 2009 Feb;27(2):70-4. doi: 10.1016/j.eimc.2008.05.001. Epub 2009 Jan 9.
Comparative study in patients with infectious diseases admitted to a specialized Internal Medicine-Infectious Diseases Department (IMID) versus those admitted to other medical departments in a university general hospital, investigating quality and cost-effectiveness.
Analysis of patients in 10 principle diagnosis-related groups (DRGs) of infectious diseases admitted to the IMID were compared to those admitted to other medical departments (2005-2006). The DRG were divided in 4 main groups: respiratory infections (DGR 88, 89, 90, 540), urinary infections (DRG 320, 321), sepsis (DRG 416, 584), and skin infections (DRG 277, 278). For each group, quality variables (mortality and readmission rate), efficacy variables (mean hospital stay and mean DRG-based cost per patient) and complexity variables (case mix, relative weight, and functional index) were analyzed.
542 patients included in the 10 main infectious disease DRGs were admitted to IMID and 2404 to other medical departments. After adjusting for DRG case mix (case mix 0.99 for IMID and 0.89 for others), mean hospital stay (5.11 days vs. 7.65 days), mortality (3.5% vs. 7.9%) and mean DRG-based economic cost per patient (1521euro/patient vs. 2952euro/patient) was significantly lower in the group of patients hospitalized in IMID than the group in other medical departments (p<0.05). The readmission rate was similar in the 2 groups (5.5% and 6.5%, respectively). The results per each DRG group were similar to the overall results.
For a similar case mix, hospitalization in IMID departments had a positive influence on the variables analyzed as compared to hospitalization in other departments, with a shorter mean stay, lower mortality, and lower mean DRG-based economic cost per patient. Creation and development of IMID departments should be an essential objective to improve healthcare quality and respond to social demands.
对一所大学综合医院中，入住内科-传染病专科（IMID）的传染病患者与入住其他内科科室的患者进行对比研究，调查医疗质量和成本效益。
分析2005 - 2006年入住IMID的10个主要传染病诊断相关分组（DRG）的患者，并与入住其他内科科室的患者进行比较。DRG分为4个主要组：呼吸道感染（DGR 88、89、90、540）、泌尿系统感染（DRG 320、321）、脓毒症（DRG 416、584）和皮肤感染（DRG 277、278）。对每组的质量变量（死亡率和再入院率）、疗效变量（平均住院天数和基于DRG的每位患者平均费用）和复杂性变量（病例组合、相对权重和功能指数）进行分析。
10个主要传染病DRG中的542例患者入住IMID，2404例入住其他内科科室。在调整DRG病例组合后（IMID的病例组合为0.99，其他科室为0.89），入住IMID的患者组的平均住院天数（5.11天对7.65天）、死亡率（3.5%对7.9%）和基于DRG的每位患者平均经济成本（1521欧元/患者对2952欧元/患者）显著低于入住其他内科科室的患者组（p<0.05）。两组的再入院率相似（分别为5.5%和6.5%）。每个DRG组的结果与总体结果相似。
对于相似的病例组合，与入住其他科室相比，入住IMID科室对所分析的变量有积极影响，平均住院时间更短、死亡率更低且基于DRG的每位患者平均经济成本更低。创建和发展IMID科室应是提高医疗质量和满足社会需求的一项重要目标。
