Wada Mikio, Nishiyama Daichi, Kawashima Atsushi, Fujiwara Misaki, Kagawa Keizo
Department of General Internal Medicine, Fukuchiyama City Hospital, Japan.
Intern Med. 2015;54(17):2161-5. doi: 10.2169/internalmedicine.54.3900. Epub 2015 Sep 1.
This study aimed to evaluate the effects of establishing a Department of General Internal Medicine (DGIM) on the length of hospitalization. We evaluated the length of hospitalization associated with diseases for which full-time specialists were not available and were instead treated by physicians of the DGIM after its establishment.
A retrospective cohort study was conducted with a review of the subjects' medical records. The subjects included patients ≥16 years of age who were hospitalized with pneumonia or cerebral infarction and treated by a physician with a specialty in internal medicine as the disease outside their specialty prior to DGIM establishment (October 1, 2006 to September 30, 2008) or by a physician of the DGIM after its establishment (October 1, 2009 to September 30, 2011). The primary outcome was the change in the length of hospitalization. The length of hospitalization for heart failure, which was treated by specialists (cardiologists) in both study periods, was also examined for comparison.
We evaluated 322 and 423 cases of pneumonia treated before and after the establishment of the DGIM, as well as 223 and 229 cases of cerebral infarction and 132 and 206 cases of heart failure, respectively. The length of hospitalization before and after establishment of the DGIM was 21.6 and 16.0 days for the pneumonia patients (p<0.001) and 24.2 and 19.9 days for the cerebral infarction patients (p<0.001), respectively. On the other hand, the change in the length of hospitalization for the heart failure patients was not statistically significant (19.9 vs. 17.6 days; p=0.281).
The establishment of the DGIM reduced the length of hospitalization associated with diseases for which full-time specialists were not available by over 17%.
本研究旨在评估设立普通内科（DGIM）对住院时长的影响。我们评估了在设立DGIM后，对于那些此前没有专职专科医生、而是由DGIM医生治疗的疾病，其相关的住院时长。
进行了一项回顾性队列研究，对受试者的病历进行审查。受试者包括年龄≥16岁、因肺炎或脑梗死住院的患者，在DGIM设立之前（2006年10月1日至2008年9月30日），这些疾病由内科专科医生作为其专科以外的疾病进行治疗，而在DGIM设立之后（2009年10月1日至2011年9月30日），则由DGIM医生进行治疗。主要结局是住院时长的变化。还对两个研究期间均由专科医生（心脏病专家）治疗的心力衰竭患者的住院时长进行了检查，以作比较。
我们分别评估了DGIM设立前后的322例和423例肺炎病例，以及223例和229例脑梗死病例，还有132例和206例心力衰竭病例。DGIM设立前后，肺炎患者的住院时长分别为21.6天和16.0天（p<0.001），脑梗死患者分别为24.2天和19.9天（p<0.001）。另一方面，心力衰竭患者住院时长的变化无统计学意义（19.9天对17.6天；p=0.281）。
DGIM的设立使那些没有专职专科医生的疾病的相关住院时长减少了超过17%。
