The assessment of complexity in internal medicine patients. The FADOI Medicomplex Study

Nardi, Roberto; Scanelli, Giovanni; Borioni, D; Grandi, Marco; Sacchetti, C; Parenti, M; Fiorino, Sirio; Iori, Ido; Donato, Carlo Di; Agostinelli, Paolo; Cipollini, Francesco; G, Pelliccia; Centurioni, Riccardo; Pontoriero, Laura

doi:10.1016/j.ejim.2006.12.006

Cited by 34 publications

(31 citation statements)

References 11 publications

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“…are less well represented and have a lower number of beds. According to the Literature [17][18][19] Internal Medicine admits mainly complex DRG related to Neurology, Cardiology as well as to the Geriatrics. Older age, together with polypharmacy, non use of formal and/or informal home-help services, history of falls, temporal disorientation, place of living and use of psychoactive drugs contribute significantly to determine the hospital admission through ER.…”

Section: Role Of Internal Medicine In the Management Of Emergency Admmentioning

confidence: 99%

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

2016

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In Italy, the number of internists has grown by 10% since 1990 reaching 11,435 units, they manage 39,000 beds in 1060 Internal Medicine (IM) wards. The Internists are expected to ensure a cost-effective management of poly-pathological and complex patients. A collaborative study between the Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) and the Consortium for Applied Health Economics Research (C.R.E.A. Sanità) based on data from hospital discharge records has been conducted starting from November 2014. In this article the preliminary results are shown with focus on emergency admissions characteristics to contribute to define the role of hospital IM. Evaluation is performed comparing emergency and planned admissions, IM impact on hospital admissions, availability of community-based healthcare services, diagnosis-related groups (DRGs) weight in IM and regional differences in managing hospital admissions with focus on IM department. In 2013 IM wards discharged 1,073,526 patients (16.18% of the total discharged by hospitals) with a total economic value of 3,426,279.88 € (average DRG 3882.80 €, from 3682.19 to 4083.42). The average length of stay (LOS) in IM was 9.3 days. IM covers 27% of admissions from Emergency Room. Determinants significantly affecting the emergency admissions are old age and comorbidities of the patients that also have a role in increasing LOS. 55% of Italian hospital admissions are emergency admissions. Hospitalization rates in emergency are systematically higher than those in election and the greatest differences are in the regions with inefficiently organized regional network. The role of the hospital IM appears central in the offer of beds to the emergency room by accepting 27% of urgent admissions. The increasing impact of IM on hospital management will put the internists as authoritative stakeholders in health policy.

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Section: Role Of Internal Medicine In the Management Of Emergency Admmentioning

confidence: 99%

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

2016

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“…Overall, mean CIRS-SI was 1.03 (SD=0.31) and median CIRS-CI was 2 (range 1-5) equivalent to a moderate comorbidity. The mean number of diagnoses at discharge was 5.9 (SD=2.3), the median number of clinical tests performed during hospitalization was 8 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], and the mean number of medications prescribed at discharge was 8 (SD=3.2).…”

Section: Resultsmentioning

confidence: 99%

“…10,11 On the other hand, clinical complexity takes into account different variables, such as number of comorbid conditions, number of daily medications, need for repeated hospitalizations over a given time period. 12 Comorbidity is defined as the coexistence of two or more disease conditions in the same subject, and is typical of the elderly; with advancing age, an increase in age-related chronic degenerative diseases is expected. 13 Comorbidities increase the duration of hospitalization, the need for re-hospitalizations, the incidence of complications and the risk of mortality compared to that of the single disease components.…”

Section: Introductionmentioning

confidence: 99%

Variables determining clinical complexity in hospitalized Internal Medicine patients: a workload analysis

et al. 2017

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“…21,22 In addition to specific organizational pathways, that have to be built together with ED units for diseases at higher risk of acute organ failure as indicated above, it is therefore essential, at the admission in the ward and throughout the course of hospital stay, a widely accepted, easily reproducible risk stratification system (triage) of the patients, to provide the better adequate care related to their actual needs. [23][24][25][26] For this purpose the IM adapted mEWS proved to be a simple and effective tool. 27,28 We share the opinion by Chesi and Nardi, 24 for which the stratification of patients for different clinical risk in IM should not be based only on vital parameters, since there are medical conditions, although with lower scores at admission, that are at higher risk of organ failure or sudden worsening, requiring, regardless of the score at admission, a close clinical monitoring.…”

Section: Discussionmentioning

confidence: 99%

The change of hospital internal medicine: a study on patients admitted in internal medicine wards of 8 hospitals of the Lazio area, Italy

et al. 2015

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The hospital internal medicine (IM) needs to adapt to the socio-demographic changes occurred during the last thirty years: patients currently show an increased overall complexity owing to the increase in the average age of the patients admitted, to more several and severe comorbidities, and a higher concentration in our wards of most severe cases. Our departments have to change in order to pursue a more efficient organization and to offer care to users modulated according to their needs and conditions. The Intensity of Care in Internal Medicine Group of the Federation of Associations of Hospital Doctors on Internal Medicine - Lazio carried out a population-based study in eight Internal Medicine wards of the region with the aim of characterizing the patients there admitted, using the modified early warning score (mEWS), monitoring and evaluating the outcomes of hospitalization. This has allowed us to determine the cut-off of the score indicating a greater statistical probability of a fatal outcome corresponding to 3, contrary to what originally reported by Subbe <em>et al.</em> in 2001. According to our results into the Departments of IM should be provided an area of high care, where monitor and stabilize the patients admitted with a mEWS score ≥3, before transferring them to the wards of lower intensity of care. This organizational model of the high care of medical patients has the benefit of offer the technical and professional assistance appropriate to the level of clinical risk, with more intensive care to more critical stages of illness.

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The assessment of complexity in internal medicine patients. The FADOI Medicomplex Study

Cited by 34 publications

References 11 publications

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

Variables determining clinical complexity in hospitalized Internal Medicine patients: a workload analysis

The change of hospital internal medicine: a study on patients admitted in internal medicine wards of 8 hospitals of the Lazio area, Italy

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