Evaluación de estadísticas hospitalarias
Objective: To characterize hospital admissions in the Internal Medicine department of a general hospital. To analyze social, economic and environmental health factors implicated in the appropriateness of admission. Methods: Were included and registered demographic parameters, hospital admi...
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| Publicado en: | Revista Médica Universitaria |
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| Autores principales: | , , |
| Materias: | |
| Acceso en línea: | https://bdigital.uncu.edu.ar/fichas.php?idobjeto=11572 |
| todos_str_mv |
11542 1221 HospLagClinMed HospLagClinMed spa Trabajo original UNCuyo FCM UNCuyo FCM |
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| descriptores_str_mv |
Admisión del paciente Atención hospitalaria Calidad de la Atención de Salud Factores socioeconómicos Hospital Luis Lagomaggiore (Mendoza, Argentina) Hospitalización Hospitalizacion inadecuada |
| disciplina_str_mv |
Ciencias médicas |
| titulo_str_mv |
Evaluación de estadísticas hospitalarias |
| autor_str_mv |
Lascano, Soledad Morea, Gastón Salomón, Susana |
| description_str_mv |
Objective:
To characterize hospital admissions in the Internal
Medicine department of a general hospital. To
analyze social, economic and environmental
health factors implicated in the appropriateness of
admission.
Methods:
Were included and registered demographic
parameters, hospital admission characteristics
(workday vs weekend/holyday, routine vs
emergency, reasons of admission), educational
level, labor and habitational conditions,
comorbidities, autonomy (basic and instrumental
activities of daily living) and performance status. A
cross-sectional and descriptive study design was
employed. An Appropriateness Evaluation Protocol
(AEP) was used as a screening tool to evaluate
inadequate admissions. Data collected was
analyzed by Epi Info 7 software at descriptive and
analytical levels.
Results:
124 admissions were included, 53% male, average
age 52.5 years old (±15.2), 43% single and 38%
married. 12% with health insurance. 88.5% lived in
Gran Mendoza. 86% of the admissions were
registered during a workday, 94% for a clinical
reasons (19% dyspnea, 16%
disorders of consciousness and 10% fever). 5% of
admitted patients were asymptomatic. 50% of
patients were admitted by the emergency
department, 33% from outpatient clinics and 18%
from other departments. Illiterate 5%, complete
elementary school 22%, complete high school 14%
and university 2%. 25% were employed, only 15%
had employment stability. Retired 6%. 28%
received subsidy (10% for disability). 14% received
social support. 13% live alone. 21% were family
support, 20% referred child care
responsibility, and 5% disabled child care. 2% were
homeless. Without drinking water supply 8%, and
17.5% without connection to the sewage network.
Average Charlson score 4 points (± 2.1), APACHE II
score 11.5 points (± 6.1), BADL 4.1 (± 2.1) and IADL
3.9 (± 2.5). 33% of the hospital admissions were
inadequate according to the level of care facilities
offered at our institution. 71% could have been
carried out in a less complex institution. The main
reasons of inappropriate admissions were
conservative clinical observation in 36.5%,
persistence of clinical syndrome and waiting time
to consolidate treatment in 17%; followed by
homeless situation, waiting time for surgical
procedure, waiting time for orthopedic supplies,
risk for continuity of outpatient care, waiting time
for complementary diagnostic procedure and
limitation of the therapeutic efforts. The
comparative analysis between appropriate vs
inappropriate admissions proved that having a low
APACHE II score (p <0.01), living outside the
metropolitan region of Gran Mendoza (p <0.05),
and having a low educational level (p <0.01) were
significantly more frequent in patients with
inadequate admissions.
Conclusion
Inappropriate admissions rate was estimated to be
33% in our study. Having a low APACHE II score,
living outside the metropolitan region of Gran
Mendoza and having a low educational level, were
significantly more frequent in patients with
inadequate admissions. The pursuit for efficiency
in hospital management should motivate the use
of measurement and screening tools to detect
these inappropriate admissions. Objetivos: Caracterizar la adecuación de la hospitalización de la población internada en un servicio de clínica médica de un hospital general de agudos. Analizar determinantes de la salud socio-económicoambientales implicados en la misma. Materiales y Métodos: Estudio protocolizado, descriptivo y transversal. Incluyó parámetros demográficos, características del ingreso hospitalario (fecha, origen y motivo de ingreso), escolaridad, situación laboral, condiciones habitacionales y convivientes, subsidios, Charlson, APACHE II, y Actividades básicas (ABVD) e instrumentales de la vida diaria (AIVD). Se evaluó la adecuación de la hospitalización mediante el Appropriateness Evaluation Protocol (AEP) modificado. Análisis estadístico: medidas de tendencia central, dispersión, ANOVA y chi2. Significancia p <0.05. Resultados: Se analizaron 124 estadías, 53% género masculino, edad media (x) 52.5 años (±15.2), 43% solteros y 38% casados. Con cobertura social 12%. Vivían en Gran Mendoza 88.5%. El 86% de las admisiones se realizaron durante un día laboral, 94% por motivos clínicos (disnea 19%, trastorno de conciencia 16% y fiebre 10%). Ingresó 5% de pacientes asintomáticos. 50% de pacientes ingresados provenían de guardia, 33% de consultorios externos y 18% pases de otros servicios. Analfabetos 5%, primario completo 22%, secundario completo 14% y universitarios 2%. Tenía trabajo 25%, solo 15% presentaba estabilidad laboral. Jubilados 6%. Referían alguna pensión 28% (10% por discapacidad). Recibían un plan social 14%. Vivían solos 13%. Eran sostén de familia 21%, presentando menores a cargo 20%, x de 1.7 menores (±1.1), y discapacitados a cargo 5%. En situación de calle 2%. Sin conexión a red de agua potable 8%, y 17.5% sin conexión a red cloacal. Charlson x 4 puntos (±2.1), APACHE II x 11.5 puntos (±6.1), ABVD x 4.1 (±2.1) y AIVD x 3.9 (±2.5). El 33% de las estadías hospitalarias fueron inadecuadas (grupo AdIn) al nivel asistencial ofrecido en nuestra institución. Podrían haberse llevado a cabo en institución de menor complejidad 71%. La observación clínica en 36.5%, falta de consolidación en el tratamiento y persistencia del cuadro clínico en 17%, fueron las causas más frecuentes, seguidas por situación de calle, espera de procedimiento quirúrgico y material ortopédico, falta de medicación ambulatoria, espera de realización de examen complementario y adecuación de esfuerzos terapéuticos. Del análisis comparativo de AdIn vs No AdIn, presentar APACHE II más bajo (p <0.01), vivir fuera de la región metropolitana de Gran Mendoza (p <0.05), y tener bajo nivel de instrucción (p <0.01) fue significativamente más frecuente en pacientes AdIn. Conclusiones La tasa de estadías hospitalarias inadecuadas en nuestro medio fue 33%. Presentar APACHE II más bajo, vivir fuera de la región metropolitana de Gran Mendoza y tener bajo nivel de instrucción, fue significativamente más frecuentes en pacientes AdIn. La búsqueda de eficiencia en gestión hospitalaria debe motivar el empleo de indicadores de gestión que permitan detectar estadías inadecuadas. |
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Textual: Revistas |
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11572 |
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Artículo de Revista |
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article |
| container_title |
Revista Médica Universitaria |
| journal_title_str |
Revista Médica Universitaria |
| journal_id_str |
r-1221 |
| container_issue |
Revista Médica Universitaria |
| container_volume |
Vol. 14, no. 2 |
| journal_issue_str |
Vol. 14, no. 2 |
| tipo_str |
textuales |
| type_str_mv |
Articulos |
| title_full |
Evaluación de estadísticas hospitalarias |
| title_fullStr |
Evaluación de estadísticas hospitalarias Evaluación de estadísticas hospitalarias |
| title_full_unstemmed |
Evaluación de estadísticas hospitalarias Evaluación de estadísticas hospitalarias |
| description |
Objective:
To characterize hospital admissions in the Internal
Medicine department of a general hospital. To
analyze social, economic and environmental
health factors implicated in the appropriateness of
admission.
Methods:
Were included and registered demographic
parameters, hospital admission characteristics
(workday vs weekend/holyday, routine vs
emergency, reasons of admission), educational
level, labor and habitational conditions,
comorbidities, autonomy (basic and instrumental
activities of daily living) and performance status. A
cross-sectional and descriptive study design was
employed. An Appropriateness Evaluation Protocol
(AEP) was used as a screening tool to evaluate
inadequate admissions. Data collected was
analyzed by Epi Info 7 software at descriptive and
analytical levels.
Results:
124 admissions were included, 53% male, average
age 52.5 years old (±15.2), 43% single and 38%
married. 12% with health insurance. 88.5% lived in
Gran Mendoza. 86% of the admissions were
registered during a workday, 94% for a clinical
reasons (19% dyspnea, 16%
disorders of consciousness and 10% fever). 5% of
admitted patients were asymptomatic. 50% of
patients were admitted by the emergency
department, 33% from outpatient clinics and 18%
from other departments. Illiterate 5%, complete
elementary school 22%, complete high school 14%
and university 2%. 25% were employed, only 15%
had employment stability. Retired 6%. 28%
received subsidy (10% for disability). 14% received
social support. 13% live alone. 21% were family
support, 20% referred child care
responsibility, and 5% disabled child care. 2% were
homeless. Without drinking water supply 8%, and
17.5% without connection to the sewage network.
Average Charlson score 4 points (± 2.1), APACHE II
score 11.5 points (± 6.1), BADL 4.1 (± 2.1) and IADL
3.9 (± 2.5). 33% of the hospital admissions were
inadequate according to the level of care facilities
offered at our institution. 71% could have been
carried out in a less complex institution. The main
reasons of inappropriate admissions were
conservative clinical observation in 36.5%,
persistence of clinical syndrome and waiting time
to consolidate treatment in 17%; followed by
homeless situation, waiting time for surgical
procedure, waiting time for orthopedic supplies,
risk for continuity of outpatient care, waiting time
for complementary diagnostic procedure and
limitation of the therapeutic efforts. The
comparative analysis between appropriate vs
inappropriate admissions proved that having a low
APACHE II score (p <0.01), living outside the
metropolitan region of Gran Mendoza (p <0.05),
and having a low educational level (p <0.01) were
significantly more frequent in patients with
inadequate admissions.
Conclusion
Inappropriate admissions rate was estimated to be
33% in our study. Having a low APACHE II score,
living outside the metropolitan region of Gran
Mendoza and having a low educational level, were
significantly more frequent in patients with
inadequate admissions. The pursuit for efficiency
in hospital management should motivate the use
of measurement and screening tools to detect
these inappropriate admissions. |
| dependencia_str_mv |
Facultad de Ciencias Médicas |
| title |
Evaluación de estadísticas hospitalarias |
| spellingShingle |
Evaluación de estadísticas hospitalarias Admisión del paciente Atención hospitalaria Calidad de la Atención de Salud Factores socioeconómicos Hospital Luis Lagomaggiore (Mendoza, Argentina) Hospitalización Hospitalizacion inadecuada Lascano, Soledad Morea, Gastón Salomón, Susana |
| topic |
Admisión del paciente Atención hospitalaria Calidad de la Atención de Salud Factores socioeconómicos Hospital Luis Lagomaggiore (Mendoza, Argentina) Hospitalización Hospitalizacion inadecuada |
| topic_facet |
Admisión del paciente Atención hospitalaria Calidad de la Atención de Salud Factores socioeconómicos Hospital Luis Lagomaggiore (Mendoza, Argentina) Hospitalización Hospitalizacion inadecuada |
| author |
Lascano, Soledad Morea, Gastón Salomón, Susana |
| author_facet |
Lascano, Soledad Morea, Gastón Salomón, Susana |
| title_sort |
Evaluación de estadísticas hospitalarias |
| title_short |
Evaluación de estadísticas hospitalarias |
| url |
https://bdigital.uncu.edu.ar/fichas.php?idobjeto=11572 |
| estado_str |
3 |
| building |
Biblioteca Digital |
| filtrotop_str |
Biblioteca Digital |
| collection |
Artículo de Revista |
| institution |
Sistema Integrado de Documentación |
| indexed_str |
2023-04-25 00:36 |
| _version_ |
1764120184065359872 |
