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Vol. 215. Issue 1.
Pages 9-17 (January - February 2015)
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Vol. 215. Issue 1.
Pages 9-17 (January - February 2015)
Original article
Multiple hospitalizations at the department of internal medicine of a tertiary hospital
Multiingreso en el Servicio de Medicina Interna de un hospital terciario
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119
D. Etxeberria-Lekuonaa,
Corresponding author
, J.M. Casas Fernández de Tejerinaa, I. Méndez Lópezb, J. Oteiza Olasoa, M. Arteaga Mazuelasb, V. Jarne Betranb
a Servicio de Medicina Interna, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
b Servicio de Medicina Interna, Hospital García Orcoyen, Estella, Navarra, Spain
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Tables (3)
Table 1. Variables analyzed in the sample and distribution according to multiple hospitalizations.
Table 2. Most common previous diseases and diagnoses significantly associated with being a patient with or without multiple hospitalizations.
Table 3. Binary logistic regression model developed to qualify a hospitalization as corresponding to a patient with multiple hospitalizations (forwards, conditional method).
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Abstract
Background and objectives

Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine.

Patients and methods

A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge.

Results

When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died.

Conclusions

Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.

Keywords:
Hospital readmission
Multiple admission patient
Chronic disease
Comorbidity
Mortality
Resumen
Antecedentes y objetivos

El paciente multiingresador origina un gran consumo de recursos sanitarios. Hemos estudiado los factores asociados con el ingreso hospitalario múltiple en una cohorte de pacientes asistidos en un Servicio de Medicina Interna.

Pacientes y métodos

Se analizaron 613 ingresos hospitalarios consecutivos. Se definió como paciente multiingresador a aquel que al ingresar contabilizaba 3 ingresos o más en los últimos 12 meses. Se analizó la relación de factores demográficos, clínicos y sociales con la característica de ser multiingresador. Además, se analizó el reingreso en los 6 meses siguientes al alta así como el fallecimiento en el ingreso y en los 6 y 12 meses siguientes al alta.

Resultados

Los multiingresadores se caracterizaron frente a los no multiingresadores por ser de sexo masculino, ser más jóvenes y presentar mayor comorbilidad, mayor consumo de medicaciones y mayor puntuación en el índice de Katz. La principal causa de ingreso de los multiingresadores fue la «descompensación de una enfermedad crónica» (87,3%). Las enfermedades que se asociaron de forma más destacada con el multiingreso fueron la insuficiencia cardiaca, la diabetes mellitus y la enfermedad pulmonar obstructiva crónica. En los 6 primeros meses tras el alta los multiingresadores presentaron más reingresos. Durante el periodo de estudio, falleció el 40,4% de los pacientes multiingresadores y el 28,8% de los pacientes no multiingresadores.

Conclusiones

Los pacientes multiingresadores presentaron mayor complejidad clínica que los no multiingresadores, y el multiingreso se asoció con las enfermedades crónicas, la polifarmacia, el deterioro funcional y tasas elevadas de mortalidad.

Palabras clave:
Reingreso hospitalario
Multiingresador
Enfermedad crónica
Comorbilidad
Mortalidad

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