Verma Amol A, Guo Yishan, Kwan Janice L, Lapointe-Shaw Lauren, Rawal Shail, Tang Terence, Weinerman Adina, Cram Peter, Dhalla Irfan A, Hwang Stephen W, Laupacis Andreas, Mamdani Muhammad M, Shadowitz Steven, Upshur Ross, Reid Robert J, Razak Fahad
Affiliations: Li Ka Shing Centre for Healthcare Analytics Research and Training (Verma, Mamdani), St. Michael's Hospital; Eliot Phillipson Clinician-Scientist Training Program (Verma), Department of Medicine, University of Toronto; Li Ka Shing Knowledge Institute (Guo, Dhalla, Hwang, Laupacis, Mamdani, Razak), St. Michael's Hospital; Department of Medicine (Kwan), Sinai Health System; Department of Medicine (Kwan, Lapointe-Shaw, Rawal, Razak, Tang, Weinerman), University of Toronto; Division of General Internal Medicine (Rawal), University Health Network; Institute for Better Health (Tang, Reid), Trillium Health Partners; Sunnybrook Health Sciences Centre (Weinerman); University Health Network, Sinai Health System (Cram), University of Toronto; Health Quality Ontario (Dhalla); Sunnybrook Health Sciences Centre (Shadowitz), University of Toronto; Bridgepoint Health (Upshur), University of Toronto, Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass.
CMAJ Open. 2017 Dec 11;5(4):E842-E849. doi: 10.9778/cmajo.20170097. Epub 2017 Dec 13.
The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area.
This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period.
There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%).
Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system.
普通内科服务所提供的医院护理的确切范围仍未得到充分量化。本研究的目的是描述大多伦多地区7个医院站点普通内科收治患者的人口统计学特征、医疗状况、健康结局及资源利用情况。
这是一项回顾性队列研究，纳入了2010年4月1日至2015年3月31日期间在研究站点普通内科住院或出院的所有患者。医院电子信息系统的临床数据与各医院的管理数据相链接。我们研究了研究期间资源利用和患者特征的趋势。
在研究期间，普通内科有136208例住院病例，涉及88121名不同患者。普通内科住院病例占急诊科所有住院病例的38.8%，占所有住院日的23.7%。在研究期间，普通内科的住院病例数增加了32.4%；住院中位时长或每次住院费用没有显著变化。患者中位年龄为73岁（四分位间距[IQR]为57 - 84岁），并存疾病的中位数量为6种（IQR为3 - 9种）。急性住院中位时长为4.6天（IQR为2.5 - 8.6天），每次住院的中位总费用为5850美元（IQR为3915 - 10,061美元）。52.2%的住院病例中患者至少接受了1次计算机断层扫描。最常见的主要出院诊断为肺炎（占住院病例的5.0%）、心力衰竭（4.7%）、慢性阻塞性肺疾病（4.1%）、尿路感染（4.0%）和中风（3.6%）。
普通内科收治的患者构成了一个庞大、异质性强、资源密集且不断增长的群体。理解并改善普通内科护理对于促进高质量、可持续的医疗保健系统至关重要。
