Outcomes and management costs in patients hospitalized for skin and skin-structure infections.

BACKGROUND: This study was conducted to determine outcomes and costs of treating complicated skin and skin-structure infections (cSSSIs) due to gram-positive only, gram-negative only, or mixed pathogens (gram-positive and gram-negative), including those with methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. METHODS: Data on length of stay (LOS), mortality, and charges for cSSSIs were compiled from claims in the multihospital Solucient database from 2002 to 2006. RESULTS: Among the 5156 cases with pathogens identified, 59.7% were gram-positive, 21.5% were gram-negative, and 18.8% were mixed. Patients with mixed pathogens incurred significantly higher LOS (17.2 days), mortality (10.2%), and charges ($80,093) than those with cSSSIs due to gram-negative pathogens (10.1 days, 6.5%, and $41,634, respectively) or to gram-positive pathogens (9.5 days, 4.8%, and $40,046, respectively). MRSA was isolated from 21.6% of all cases and from 26.3% of cases involving mixed pathogens. MRSA cases had significantly longer LOS and greater mortality than non-MRSA cases, but similar total charges. P aeruginosa occurred in 13.3% of all cases and in 36.3% of cases involving mixed pathogens. P aeruginosa cases had significantly higher LOS and charges compared with non‒P aeruginosa cases. CONCLUSION: Although gram-positive pathogens were the most common causes of cSSSIs, cases involving mixed and resistant pathogens were associated with longer LOS, greater mortality, and higher total charges.

Pertinencia de remisiones generadas en la red adscrita de la Secretaría Distrital de Salud de Bogotá / Relevance of referrals generated in the network of the District Health Secretariat of Bogota

Objetivos La pertinencia en las remisiones de pacientes del Distrito Capital, generadas por los servicios de consulta externa, urgencia y hospitalización de 32 empresas sociales del Estado (ESE). Caracterizar los procesos involucrados con la referencia y contrarreferencia de pacientes pertenecientes al régimen subsidiado o vinculado del Distrito Capital. Metodología Se realizó un estudio transversal, recolectándose información de 1,513 remisiones. Se estableció la pertinencia en la decisión médica de acuerdo con la capacidad técnica de la IPS para atender adecuadamente la enfermedad del paciente. En el análisis cualitativo se realizó un estudio tipo teoría, partiendo de las experiencias de los usuarios y los prestadores de servicios. Resultados El 80% de las remisiones fueron pertinentes en la decisión médica y el 20% no. El direccionamiento fue adecuado en el 50.4% de las remisiones y no adecuado en el 49.6%. Las remisiones efectivas fueron el 53.1% del total. Conclusiones Los problemas en la decisión de la remisión y la baja proporción de adecuación en el direccionamiento evidencian problemas en la decisión médica, coordinación y comunicación deficiente, falta de definición de procedimientos y ausencia de sistemas de evaluación periódica.

Objectives The relevance of referrals of patients from the Capital District, generated by the outpatient, emergency and hospitalization services of 32 social enterprises of the State (ESE). To characterize the processes involved with the referral and counter-referral of patients belonging to the subsidized or linked regime of the Capital District. Methodology A cross-sectional study was carried out, collecting information from 1,513 referrals. The relevance of the medical decision was established according to the technical capacity of the IPS to adequately attend the patient's disease. In the qualitative analysis, a theory-type study was carried out, based on the experiences of users and service providers. Results Eighty percent of the referrals were pertinent in the medical decision and 20% were not. Referrals were appropriate in 50.4% of referrals and not appropriate in 49.6%. Effective referrals were 53.1% of the total. Conclusions The problems in the referral decision and the low proportion of adequate referrals are evidence of problems in the medical decision, poor coordination and communication, lack of definition of procedures and absence of periodic evaluation systems.