QJM Advance Access originally published online on January 15, 2009
QJM 2009 102(3):193-202; doi:10.1093/qjmed/hcn172
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The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: A cross-sectional analysis in a tertiary hospital
From the 1Integrated Care Unit, Respiratory, Endocrinology and Rheumatology Services and Preventive Medicine and Epidemiology Department (UASP), Hospital Clínic, CIBERES, IDIBAPS, University of Barcelona and 2Centre for Research in Environmental Epidemiology (CREAL), IMIM, CIBERESP, Barcelona, Spain
Address correspondence to C. Hernandez, Department of Medical and Nursing Direction, Hospital Clininc, Villarroel 170, Barcelona, Spain. email: chernan{at}clinic.ub.es
Received 14 August 2008 and in revised form 8 December 2008
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Abstract |
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Background: Chronic disorders constitute a primary concern because of their burden on healthcare systems worldwide. Integrated care strategies enhancing the interface between tertiary care and primary care are pivotal to improve chronic care.
Aim: To asses the prevalence of chronic disorders on hospital discharges and their impact on unplanned admissions and mortality.
Design: Cross-sectional analysis of discharge information over 1 year (2004) in one University hospital.
Methods: Adoption of an operational definition of chronic disorder based on the WHO. Main outcome: co-morbid conditions, emergency room and hospital admissions, outpatient consultations and mortality.
Results: Fifty-eight percent of patients presented at least one chronic condition (19 192 patients, 53% males, 63 ± 18 years) as primary (12 526 patients, 38%) or secondary diagnosis. The Charlson index was 2 ± 3. Each chronic condition was associated with a 30% increase of having had an admission in the previous year. Up to 9% (1 656) of chronic patients showed multiple admissions in the previous year: two (917 patients, 55%), three (360, 22%) and four or beyond (379, 23%), being mostly unscheduled hospitalizations. The three most prevalent chronic disorders were cancer, cardiovascular diseases and chronic obstructive pulmonary disease (COPD). The rate of admissions was associated with co-morbidity (P < 0.001) and mortality (P < 0.001).
Conclusions: The study shows a high impact of cancer on planned hospitalizations whereas cardiovascular diseases and COPD generates a high percentage of unscheduled admissions. We conclude that integrated care services including patient-oriented guidelines are strongly needed to enhance both health and managerial outcomes.