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Population-Based Trends in Complexity of Hospital Inpatients.
Naik, Hiten; Murray, Tyler M; Khan, Mayesha; Daly-Grafstein, Daniel; Liu, Guiping; Kassen, Barry O; Onrot, Jake; Sutherland, Jason M; Staples, John A.
Afiliación
  • Naik H; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Murray TM; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Khan M; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Daly-Grafstein D; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Liu G; Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Kassen BO; Center for Health Services and Policy Research (CHSPR), School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Onrot J; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Sutherland JM; Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
  • Staples JA; Center for Health Services and Policy Research (CHSPR), School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Intern Med ; 184(2): 183-192, 2024 Feb 01.
Article en En | MEDLINE | ID: mdl-38190179
ABSTRACT
Importance Clinical experience suggests that hospital inpatients have become more complex over time, but few studies have evaluated this impression.

Objective:

To assess whether there has been an increase in measures of hospital inpatient complexity over a 15-year period. Design, Setting and

Participants:

This cohort study used population-based administrative health data from nonelective hospitalizations from April 1, 2002, to January 31, 2017, to describe trends in the complexity of inpatients in British Columbia, Canada. Hospitalizations were included for individuals 18 years and older and for which the most responsible diagnosis did not correspond to pregnancy, childbirth, the puerperal period, or the perinatal period. Data analysis was performed from July to November 2023. Exposure The passage of time (15-year study interval). Main Outcomes and

Measures:

Measures of complexity included patient characteristics at the time of admission (eg, advanced age, multimorbidity, polypharmacy, recent hospitalization), features of the index hospitalization (eg, admission via the emergency department, multiple acute medical problems, use of intensive care, prolonged length of stay, in-hospital adverse events, in-hospital death), and 30-day outcomes after hospital discharge (eg, unplanned readmission, all-cause mortality). Logistic regression was used to estimate the relative change in each measure of complexity over the entire 15-year study interval.

Results:

The final study cohort included 3 367 463 nonelective acute care hospital admissions occurring among 1 272 444 unique individuals (median [IQR] age, 66 [48-79] years; 49.1% female and 50.8% male individuals). Relative to the beginning of the study interval, inpatients at the end of the study interval were more likely to have been admitted via the emergency department (odds ratio [OR], 2.74; 95% CI, 2.71-2.77), to have multimorbidity (OR, 1.50; 95% CI, 1.47-1.53) and polypharmacy (OR, 1.82; 95% CI, 1.78-1.85) at presentation, to receive treatment for 5 or more acute medical issues (OR, 2.06; 95% CI, 2.02-2.09), and to experience an in-hospital adverse event (OR, 1.20; 95% CI, 1.19-1.22). The likelihood of an intensive care unit stay and of in-hospital death declined over the study interval (OR, 0.96; 95% CI, 0.95-0.97, and OR, 0.81; 95% CI, 0.80-0.83, respectively), but the risks of unplanned readmission and death in the 30 days after discharge increased (OR, 1.14; 95% CI, 1.12-1.16, and OR, 1.28; 95% CI, 1.25-1.31, respectively). Conclusions and Relevance By most measures, hospital inpatients have become more complex over time. Health system planning should account for these trends.
Asunto(s)

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Readmisión del Paciente / Pacientes Internos Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Idioma: En Revista: JAMA Intern Med Año: 2024 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Readmisión del Paciente / Pacientes Internos Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Idioma: En Revista: JAMA Intern Med Año: 2024 Tipo del documento: Article