Lacerda Ana Forjaz, Oliveira Graça, Cancelinha Cândida, Lopes Silvia
Observatório Português de Cuidados Paliativos. Instituto de Ciências da Saúde. Universidade Católica Portuguesa. Lisboa. Serviço de Pediatria. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal.
Departamento de Pediatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
Acta Med Port. 2019 Aug 1;32(7-8):488-498. doi: 10.20344/amp.10437.
Due to epidemiological change, interest in complex chronic conditions has been increasing within the pediatric health system. As such, we aim to evaluate hospital inpatient care in the National Health Service (mainland Portugal) by pediatric patients (0 - 17 years) with complex chronic conditions.
Observational longitudinal retrospective epidemiological study using anonymized administrative data. We selected hospitalizations within the pediatric age limit, 2011 - 2015; healthy newborns and radiotherapy outpatients were excluded. A descriptive analysis of the admissions with complex chronic conditions was analysed by number of complex chronic conditions categories and by complex chronic conditions categories. Non-parametric tests were applied to length of stay, expense, and mortality.
Out of 419 927 admissions, 64 918 (15.5%) contained at least one complex chronic conditions code. These admissions due to complex chronic conditions represented 29.8% of hospital days, 39.4% of expense and 87.2% of deaths. Compared to those without complex chronic conditions, expense was double (median €1467 vs €745) and mortality 40 times higher (2.4% vs 0.06%). Of these, 46% were planned (no complex chronic conditions 23.2%); 64.8% occurred in group III - IV hospitals (no complex chronic conditions 27.1%). Malignant was the most frequent category (23.0%); neonatal had the highest median length of stay (12 days, 6 - 41), median expense (€3568,929 - 24 602), and number of deaths (43.5% of total).
As in other developed countries where the number of pediatric admissions is decreasing, in mainland Portugal we found an increase in the proportion of complex chronic conditions admissions, which are longer, costlier and deadlier (trends intensified in the presence of two or more complex chronic conditions categories).
Complex chronic conditions are relevant in the activity and costs regarding pediatric hospitalizations in mainland Portugal. Recognizing this and integrating pediatric palliative care from the moment of diagnosis are essential to promote appropriate hospital use, through the development of effective and sustainable alternatives that meet the needs of children, families, and healthcare professionals.
由于流行病学的变化，儿科医疗系统对复杂慢性病的关注度不断提高。因此，我们旨在评估葡萄牙大陆国家医疗服务体系中0至17岁患有复杂慢性病的儿科患者的住院治疗情况。
采用匿名行政数据进行观察性纵向回顾性流行病学研究。我们选取了2011年至2015年儿科年龄范围内的住院病例；健康新生儿和放疗门诊患者被排除在外。对患有复杂慢性病的住院病例按复杂慢性病类别数量和复杂慢性病类别进行描述性分析。对住院时间、费用和死亡率应用非参数检验。
在419927例住院病例中，64918例（15.5%）至少包含一个复杂慢性病编码。这些因复杂慢性病导致的住院病例占住院天数的29.8%、费用的39.4%和死亡病例的87.2%。与无复杂慢性病的病例相比，费用翻倍（中位数分别为1467欧元和745欧元），死亡率高出40倍（2.4%对0.06%）。其中，46%为计划性住院（无复杂慢性病的为23.2%）；64.8%发生在三级至四级医院（无复杂慢性病的为27.1%）。恶性疾病是最常见的类别（23.0%）；新生儿的住院时间中位数最长（12天，范围6至41天），费用中位数最高（3568.929欧元至24602欧元），死亡人数占总数的43.5%。
与其他儿科住院人数在减少的发达国家一样，在葡萄牙大陆，我们发现复杂慢性病住院病例的比例有所增加，这些病例住院时间更长、费用更高且更致命（在存在两种或更多复杂慢性病类别的情况下，这些趋势更加明显）。
复杂慢性病在葡萄牙大陆儿科住院的活动和费用方面具有重要意义。认识到这一点并从诊断之时起整合儿科姑息治疗，对于通过开发满足儿童、家庭和医疗专业人员需求的有效且可持续的替代方案来促进合理利用医院资源至关重要。
