[Analysis of infectious diseases care in Spanish hospitals from 2016-2020, including the first year of the SARS-CoV-2 pandemic]. / Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2.

Aims: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2 / Analysis of infectious diseases care in Spanish hospitals from 2016–2020, including the first year of the SARS-CoV-2 pandemic

Objetivo Revisar los pacientes atendidos en los hospitales españoles dados de alta con un diagnóstico principal de infección en un periodo de 5 años, incluyendo el primer año de la pandemia por SARS-CoV-2. Material y métodos Se han analizado los datos del Conjunto Mínimo Básico de Datos (CMBD) de los pacientes dados de alta durante el periodo 2016-2020 de los hospitales del Sistema Nacional de Salud de España identificando aquellos que tuvieran un diagnóstico principal de enfermedad infecciosa según el código CIE-10-S. Se han incluido en el análisis todos los pacientes mayores de 14 años que hubieran ingresado en una planta convencional o de cuidados intensivos, excluyendo los partos, y se han evaluado las altas en función del servicio de alta. Resultados Los pacientes dados de alta con patología infecciosa han aumentado del 10% al 19% en los últimos años, y gran parte del crecimiento se debe a la epidemia por SARS-CoV-2. Los servicios de medicina interna atienden a más del 50% de estos pacientes, seguidos de neumología (9%) y cirugía general (5%). En el año 2020 el 57% de los pacientes con diagnóstico principal de infección fueron dados de alta por internistas, que atendieron al 67% de los pacientes con SARS-CoV-2. Conclusiones Actualmente más de la mitad de los pacientes que ingresan con diagnóstico principal de infección son dados de alta en medicina interna. Dada la complejidad creciente de las infecciones, abogamos por un abordaje en el que un área de capacitación permita una especialización, pero dentro de un contexto generalista, para el mejor manejo de estos pacientes (AU)

Aims This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients (AU)

Analysis of infectious diseases care in Spanish hospitals from 2016 to 2020, including the first year of the SARS-CoV-2 pandemic.

AIMS: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. MATERIALS AND METHOD: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016⬜2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. RESULTS: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. CONCLUSIONS: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

[What do we know about the origin of COVID-19 three years later?] / ¿Qué sabemos del origen del COVID-19 tres años después?

More than three years have passed since the first case of a new coronavirus infection (SARS-CoV-2) in the city of Wuhan (Hubei, China). The Wuhan Institute of Virology was founded in that city in 1956 and the country's first biosafety level 4 laboratory opened within that center in 2015. The coincidence that the first cases of infection emerged in the city where the virology institute's headquarters is located, the failure to 100% identify the virus' RNA in any of the coronaviruses isolated in bats, and the lack of evidence on a possible intermediate animal host in the contagion's transmission make it so that at present, there are doubts about the real origin of SARS-CoV-2. This article will review two theories: SARS-CoV-2 as a virus of zoonotic origin or as a leak from the high-level biosafety laboratory in Wuhan.

¿Qué sabemos del origen del COVID-19 tres años después? / What do we know about the origin of COVID-19 three years later?

More than three years have passed since the first case of a new coronavirus infection (SARS-CoV-2) in the city of Wuhan (Hubei, China). The Wuhan Institute of Virology was founded in that city in 1956 and the country’s first biosafety level 4 laboratory opened within that center in 2015. The coincidence that the first cases of infection emerged in the city where the virology institute’s headquarters is located, the failure to 100% identify the virus’ RNA in any of the coronaviruses isolated in bats, and the lack of evidence on a possible intermediate animal host in the contagion’s transmission make it so that at present, there are doubts about the real origin of SARS-CoV-2. This article will review two theories: SARS-CoV-2 as a virus of zoonotic origin or as a leak from the high-level biosafety laboratory in Wuhan (AU)

Han pasado más de tres años desde el primer caso de infección por un nuevo coronavirus (SARS-CoV-2) en la ciudad de Wuhan (Hubei, China). En esta misma ciudad se fundó en 1956 el Instituto de Virología de Wuhan y en 2015 abrieron en este centro el primer laboratorio de bioseguridad de nivel 4 del país. La coincidencia de ciudad entre los primeros casos de infección y la sede del instituto de virología, sumados a la fallida identificación del RNA del virus al 100% en ninguno de los coronavirus aislados en murciélagos, junto con la falta de evidencia sobre el posible animal intermediario en la transmisión de contagio, hacen que a fecha de hoy surjan dudas sobre el origen real del SARS-CoV-2. En este artículo revisaremos dos teorías, el SARS-CoV-2 como origen zoonótico o como escape del laboratorio de alta bioseguridad en Wuhan (AU)

What do we know about the origin of COVID-19 three years later?

More than three years have passed since the first case of a new coronavirus infection (SARS-CoV-2) in the city of Wuhan (Hubei, China). The Wuhan Institute of Virology was founded in that city in 1956 and the country's first biosafety level 4 laboratory opened within that center in 2015. The coincidence that the first cases of infection emerged in the city where the virology institute's headquarters is located, the failure to 100% identify the virus' RNA in any of the coronaviruses isolated in bats, and the lack of evidence on a possible intermediate animal host in the contagion's transmission make it so that at present, there are doubts about the real origin of SARS-CoV-2. This article will review two theories: SARS-CoV-2 as a virus of zoonotic origin or as a leak from the high-level biosafety laboratory in Wuhan.

RECALMIN IV. Evolución de la actividad de las unidades de medicina interna del Sistema Nacional de Salud (2008-2021) / RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008-2021)

Objetivos Analizar la estructura, la actividad y los resultados de los servicios y unidades de medicina interna (UMI) del Sistema Nacional de Salud (SNS). Analizar los retos para la especialidad y realizar propuestas de políticas de mejora. Comparar los resultados de la encuesta RECALMIN 2021 con las anteriores oleadas de encuestas a las UMI (2008, 2015, 2017, 2019). Material y métodos Estudio descriptivo transversal entre las UMI en hospitales generales de agudos del SNS con datos referidos a 2020, comparándolos con los anteriores estudios. Las variables de estudio fueron recogidas mediante un cuestionario ad hoc. Resultados Entre 2014 y 2020 aumentó la frecuentación hospitalaria y las altas dadas por las UMI (promedio anual de 4 y 3,8%, respectivamente), así como las tasas interconsultas hospitalarias y primeras consultas (promedio anual: 2,1% en ambos casos). En 2020 aumentaron notablemente las consultas no presenciales. La mortalidad ajustada por riesgo y la estancia hospitalaria no mostraron cambios significativos en 2013-2020. Los progresos en la implantación de buenas prácticas y de una atención sistemática al paciente crónico complejo fueron escasos. Una constante en las encuestas RECALMIN es la variabilidad entre UMI en recursos y actividad, sin encontrarse diferencias estadísticamente significativas en relación con los resultados. Conclusiones Existe un notable margen de mejora en el funcionamiento de las UMI. La reducción de la variabilidad no justificada en la práctica clínica y las desigualdades en los resultados en salud deben ser un reto para los responsables de las UMI y para la Sociedad Española de Medicina Interna (AU)

Aims This work aims to analyze the structure, activity, and outcomes of internal medicine units and departments (IMU) of the Spanish National Health System (SNHS) and to analyze the challenges for the specialty and propose policies for improvement. It also aims to compare the results from the 2021 RECALMIN survey with IMU surveys from previous years (2008, 2015, 2017, 2019). Methods This work is a cross-sectional, descriptive study of IMUs in acute care general hospitals of the SNHS that compares data from 2020 with previous studies. The study variables were collected through an ad hoc questionnaire. Results Between 2014 and 2020, hospital occupancy and discharges by IMU increased (annual mean of 4% and 3.8%, respectively), as did hospital cross-consultation and initial consultation rates (2.1% in both cases). E-consultations increased notably in 2020. Risk-adjusted mortality and length of hospital stay did not show significant changes from 2013-2020. Progress in the implementation of good practices and systematic care for complex chronic patients was limited. A consistent finding in RECALMIN surveys was the variability among IMUs in terms of resources and activity, though no statistically significant differences were found in regard to outcomes. Conclusions There is considerable room for improvement in the operation of IMUs. The reduction in unjustified variability in clinical practice and inequities in health outcomes are a challenge for IMU managers and the Spanish Society of Internal Medicine (AU)

RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008-2021).

AIMS: This work aims to analyze the structure, activity, and outcomes of internal medicine units and departments (IMU) of the Spanish National Health System (SNHS) and to analyze the challenges for the specialty and propose policies for improvement. It also aims to compare the results from the 2021 RECALMIN survey with IMU surveys from previous years (2008, 2015, 2017, 2019). METHODS: This work is a cross-sectional, descriptive study of IMUs in acute care general hospitals of the SNHS that compares data from 2020 with previous studies. The study variables were collected through an ad hoc questionnaire. RESULTS: Between 2014 and 2020, hospital occupancy and discharges by IMU increased (annual mean of 4% and 3.8%, respectively), as did hospital cross-consultation and initial consultation rates (2.1% in both cases). E-consultations increased notably in 2020. Risk-adjusted mortality and length of hospital stay did not show significant changes from 2013-2020. Progress in the implementation of good practices and systematic care for complex chronic patients was limited. A consistent finding in RECALMIN surveys was the variability among IMUs in terms of resources and activity, though no statistically significant differences were found in regard to outcomes. CONCLUSIONS: There is considerable room for improvement in the operation of IMUs. The reduction in unjustified variability in clinical practice and inequities in health outcomes are a challenge for IMU managers and the Spanish Society of Internal Medicine.

Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation: A cross-sectional study.

OBJECTIVE: To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments. METHODS: One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA). RESULTS: We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; p = .039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; p = .006). DISCUSSION: A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population.

Uso de terapia antihiperglucemiante con beneficio cardiovascular en pacientes con diabetes tipo 2 que requieren hospitalización: un estudio transversal / Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation: A cross-sectional study

Objetivo Evaluar el uso de la terapia con beneficio cardiovascular en pacientes con DM tipo 2 previo al ingreso en servicios de medicina interna. Métodos Estudio transversal en un día de los pacientes con DM tipo 2 hospitalizados en servicios de medicina interna. Se recogieron variables demográficas y antropométricas, datos de laboratorio y utilización de fármacos antihiperglucemiantes. La variable desenlace fue la proporción y los determinantes de uso de inhibidores del cotransportador sodio-glucosa 2 (iSGLT2) y de agonistas del receptor del péptido similar al glucagón tipo 1 (AR-GLP1). Resultados Se incluyeron 928 pacientes pertenecientes a 74 hospitales. La edad media fue 78,9 años (DE: 10,86), un 50% varones. Un total de 557 (60%) presentaba cardiopatía isquémica, 189 (20,4%) enfermedad cerebrovascular, 293 (31,6%) insuficiencia cardiaca, 274 (29,5%) enfermedad renal crónica y 129 (13,9%) enfermedad arterial periférica. Los antihiperglucemiantes utilizados previo al ingreso fueron: sulfonilureas (5.7%), biguanidas (49.1%), inhibidores de la alfa-glucosidasa (0,2%), pioglitazona (0%), iDPP4 (39%), iSGLT2 (5,8%), AR-GLP1 (2,6%) y análogos de insulina basal (24%). La edad mayor de 75 años fue el factor determinante principal para no utilizar iSGLT2 (OR ajustada 0,28; intervalo de confianza al 95%: 0,10-0,74; p=0,039) o AR-GLP1 (OR ajustada 0,09; intervalo de confianza al 95%: 0,02-0,46; p=0,006). Discusión Una gran proporción de pacientes ancianos con DM tipo 2 de muy alto riesgo cardiovascular no recibe terapia antihiperglucemiante con fármacos de probado beneficio cardiovascular. El tratamiento más frecuentemente utilizado fue metformina e iDPP4. Existe un margen de mejora en el tratamiento en esta población de muy alto riesgo (AU)

Objective To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments. Methods One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA). Results We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; P=.039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; P=.006). Discussion A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population (AU)

Propuestas de cambio organizativo en la buena dirección / Proposed organisational changes in the right direction

No disponible

Más que internistas / More than just internists

No disponible

Utility of lateral flow tests in SARS-CoV-2 infection monitorization.

OBJECTIVE: The diagnosis of SARS-CoV-2 infection is crucial for medical and public health reasons, to allow the best treatment of cases and the best control of the pandemic. Serology testing allows for the detection of asymptomatic infections and 19-COVID cases once the virus has been cleared. We analyzed the usefulness of the SARS-CoV-2 rapid test of Autobio and tried to correlate its pattern with the severity of COVID19 infection. METHODS: We analyzed the accuracy and clinical usefulness of a point-of-care IgM and/or IgG test for SARS-CoV-2 in 35 COVID-19 patients [12 (34.3%) mild-moderate and 23 (65.7%) severe-critical] admitted to a field hospital in Madrid, as well as in 5 controls. RESULTS: The mean time from the first day of symptoms to the antibody test was 28 days (SD: 8.7), similar according to the severity of the disease. All patients with SARS-CoV-2 PCR+ showed the corresponding IgG positivity, while these results were negative in all control individuals. A total of 26 (74%) cases also presented with positive IgM, 19 (83%) were severe-critical cases and 7 (58%) were mild-moderate cases. The IgM response lasted longer in the severe critical cases (mean: 29.7 days; SD: 8.4) compared to the moderate cases (mean: 21.2 days; SD: 2.0).. CONCLUSIONS: Rapid serology tests are useful for the diagnosis of patients with COVID-19 (mainly IgG detection) and may also be correlated with the severity of the infection (based on IgM detection).

Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation: A cross-sectional study. / Uso de terapia antihiperglucemiante con beneficio cardiovascular en pacientes con diabetes tipo 2 que requieren hospitalización: un estudio transversal.

OBJECTIVE: To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments. METHODS: One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA). RESULTS: We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; P=.039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; P=.006). DISCUSSION: A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population.

Inpatient hospital fatality related to coding (ICD-9-CM) of the influenza diagnosis in Spain (2009-2015).

BACKGROUND: To analyze hospitalization episodes with an ICD-9 diagnosis code of influenza (codes 487 and 488) in any diagnostic position from 2009 to 2015 in the Spanish hospital surveillance system. METHODS: Information about age, length of stay in hospital, mortality, comorbidity with an influenza diagnosis code between 1 October 2009 and 30 September 2015 was obtained from the National Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos, CMBD). RESULTS: 52,884 hospital admissions were obtained. A total of 24,527 admissions corresponded to diagnoses ICD-9 code 487 (46.4%), and 28,357 (53.6%) corresponded to ICD-9 code 488. The global hospitalization rates were 8.7 and 10.6 per 100,000 people, respectively. Differences between the two diagnostic groups were found for each of the six analyzed seasons. The diagnostic ICD-9-CM 488, male gender, and high-risk patients classified by risk vaccination groups showed direct relationship with inpatient hospital death. CONCLUSIONS: Influenza diagnosis was present in a significant number of hospital admissions. The code used for diagnosis (ICD-9-CM 488), male sex, age groups and associated risk clinical conditions showed a direct relationship with inpatient hospital fatality.

RECALMIN. Cuatro años de evolución de las Unidades de Medicina Interna del Sistema Nacional de Salud (2013-2016) / RECALMIN. Four years of growth of the internal medicine units of the Spanish National Health System (2013-2016)

Objetivos: Comparar la estructura, recursos y actividad de las Unidades de Medicina Interna (UMI) del Sistema Nacional de Salud (SNS) en 2013 y 2016. Analizar las diferencias entre UMI en 2016 por tamaño de hospital. Material y métodos: Comparativa de 2 estudios descriptivos transversales de UMI en hospitales generales de agudos del Sistema Nacional de Salud con datos referidos a 2013 y a 2016. Las variables fueron recogidas mediante un cuestionario «ad hoc» (encuesta RECALMIN). Resultados: Entre 2013 y 2016 aumentó notablemente la demanda asistencial (con un promedio anual del 11% en altas de hospitalización y del 16% en primeras consultas) y ligeramente la comorbilidad (2%). En el mismo período, aumentó un 16,7% la productividad media de las UMI (0,6+0,3 vs. 0,7+0,3; p=0,09) y la estancia media disminuyó un 10% (9+2,2 vs. 8,1+2,1 días; p=0,001). Los progresos en la implantación de buenas prácticas y de una atención sistemática al paciente crónico complejo fueron escasos. La variabilidad entre UMI y las notables diferencias entre UMI de hospitales de tamaño distinto fueron hallazgos de ambas encuestas. Conclusiones: Las UMI respondieron al aumento de la carga asistencial que soportaron en el período 2013-2016 mejorando su eficiencia y productividad, pero los avances en la implantación de buenas prácticas, incluyendo la atención al paciente crónico complejo, fueron escasos. La importante variabilidad en los indicadores de estructura, actividad y modelos de gestión encontrada en 2013 se mantuvo en 2016

Objectives: To compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyse the differences between IMUs in 2016 by hospital size. Material and methods: We conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). Results: Between 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6±0.3 vs. 0.7±0.3; P=.09), and the mean stay decreased 10% (9±2.2 vs. 8.1±2.1 days; P=.001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. Conclusions: IMUs responded to the increased burden of care they supported during 2013-2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016