Gual Neus, Yuste Font Anna, Enfedaque Montes Belen, Blay Pueyo Carles, Martín Álvarez Remedios, Inzitari Marco
Hospital d'Atenció Intermèdia Parc Sanitari Pere Virgili, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.
Hospital d'Atenció Intermèdia Parc Sanitari Pere Virgili, Barcelona, España.
Aten Primaria. 2017 Nov;49(9):510-517. doi: 10.1016/j.aprim.2016.11.010. Epub 2017 Mar 11.
To improve the management of geriatric pluripathologic patients in Catalonia, the identification of chronic complex patient (PCC) or patients with advanced chronic disease (MACA) has been promoted. Patients with exacerbated chronic diseases are promoted to be admitted in subacute units (SG) located in intermediate hospitals and specialized in geriatric care, as an alternative to acute hospital. The results of the care process in patients identified as PCC/MACA in SG have not been evaluated.
Descriptive-comparative, cross-sectional, and quantitative study.
SG located in intermediate care hospital.
Consecutive patients admitted in the SG during 6months.
We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30days post-discharge between PCC/MACA patients versus other patients.
Of 244 patients (mean age±SD=85,6±7,5; 65.6%women), 91 (37,3%) were PCC/MACA (PCC=79,1%, MACA=20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson index=3,2±1,8 vs 2,0; p=0,001) and polypharmacy (9,5±3,7 drugs vs 8,1±3,8; p=0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30day post-discharge (15,4% vs 8%; p=0,010). In a multi-variable analysis, PCC/MACA identification (p=0,006), as well as a history of dementia (p=0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30day (18,7% vs 10,5%; p=0,014), in the multivariable analyses, only male, polypharmacy, and heart failure were independently associated to readmission.
Despite having more comorbidity and polypharmacy, the outcomes of patients identified as PCC/MACA at discharge of SG, were comparable with other patients, although they experienced more readmissions within 30days, possibly due to comorbidity and polypharmacy.
为改善加泰罗尼亚老年多病患者的管理，已推动对慢性复杂患者（PCC）或晚期慢性病患者（MACA）的识别。患有慢性疾病急性加重的患者被鼓励入住中级医院中专门提供老年护理的亚急性病房（SG），作为急性医院之外的另一种选择。在SG中被识别为PCC/MACA的患者的护理过程结果尚未得到评估。
描述性比较、横断面定量研究。
位于中级护理医院的SG。
连续6个月内在SG住院的患者。
我们比较了PCC/MACA患者与其他患者的基线特征（人口统计学、临床和老年评估数据）、出院时及出院后30天的结果。
在244例患者中（平均年龄±标准差=85.6±7.5岁；65.6%为女性），91例（37.3%）为PCC/MACA（PCC占79.1%，MACA占20.9%）。与未被识别的患者相比，这些患者合并症更多（查尔森指数=3.2±1.8对2.0；p=0.001）且用药种类更多（9.5±3.7种药物对8.1±3.8种；p=0.009）。出院时，回到常住地的情况和死亡率相当。加上出院后30天的死亡率，PCC/MACA的死亡率更高（15.4%对8%；p=0.010）。在多变量分析中，PCC/MACA的识别（p=0.006）以及痴呆病史（p=0.004）与死亡率相关。尽管PCC/MACA患者在30天时再入院率更高（18.7%对10.5%；p=0.014），但在多变量分析中，只有男性、用药种类多和心力衰竭与再入院独立相关。
尽管PCC/MACA患者合并症更多且用药种类更多，但在SG出院时，被识别为PCC/MACA的患者的结果与其他患者相当，尽管他们在30天内经历了更多再入院情况，这可能是由于合并症和用药种类多所致。
