Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study

被引:1
作者
Ramirez, Giuseppe A. [1 ,2 ,3 ]
Damanti, Sarah [2 ,3 ]
Caruso, Pier Francesco [2 ,3 ]
Mette, Francesca [2 ,3 ]
Pagliula, Gaia [2 ,3 ]
Cariddi, Adriana [1 ,2 ,3 ]
Sartorelli, Silvia [1 ,2 ,3 ]
Falbo, Elisabetta [2 ,3 ]
Scotti, Raffaella [3 ]
Di Terlizzi, Gaetano [3 ]
Dagna, Lorenzo [1 ,2 ]
Praderio, Luisa [3 ]
Sabbadini, Maria Grazia [2 ,3 ]
Bozzolo, Enrica P. [3 ]
Tresoldi, Moreno [3 ]
机构
[1] IRCCS Osped San Raffaele, Unit Immunol Rheumatol Allergy & Rare Dis, I-20132 Milan, Italy
[2] Univ Vita Salute San Raffaele, Fac Med, I-20132 Milan, Italy
[3] IRCCS Osped San Raffaele, Unit Gen Med & Adv Care, I-20132 Milan, Italy
来源
JOURNAL OF PERSONALIZED MEDICINE | 2024年 / 14卷 / 01期
关键词
sustainability; general internal medicine; healthcare resources; hospital-acquired infections; length of stay; in-hospital mortality; LENGTH-OF-STAY; NOSOCOMIAL INFECTIONS; SECONDARY INFECTIONS; CARE; COVID-19; MORTALITY; ADMISSION; IMPACT; COSTS; SCORE;
D O I
10.3390/jpm14010115
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Population aging and multimorbidity challenge health system sustainability, but the role of assistance-related variables rather than individual pathophysiological factors in determining patient outcomes is unclear. To identify assistance-related determinants of sustainable hospital healthcare, all patients hospitalised in an Internal Medicine Unit (n = 1073) were enrolled in a prospective year-long observational study and split 2:1 into a training (n = 726) and a validation subset (n = 347). Demographics, comorbidities, provenance setting, estimates of complexity (cumulative illness rating scale, CIRS: total, comorbidity, CIRS-CI, and severity, CIRS-SI subscores) and intensity of care (nine equivalents of manpower score, NEMS) were analysed at individual and Unit levels along with variations in healthcare personnel as determinants of in-hospital mortality, length of stay and nosocomial infections. Advanced age, higher CIRS-SI, end-stage cancer, and the absence of immune-mediated diseases were correlated with higher mortality. Admission from nursing homes or intensive care units, dependency on activity of daily living, community- or hospital-acquired infections, oxygen support and the number of exits from the Unit along with patient/physician ratios were associated with prolonged hospitalisations. Upper gastrointestinal tract disorders, advanced age and higher CIRS-SI were associated with nosocomial infections. In addition to demographic variables and multimorbidity, physician number and assistance context affect hospitalisation outcomes and healthcare sustainability.
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页数:14
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