[Clinical and economic analysis of an internal medicine-infectious disease department at a university general hospital (2005-2006)]. / Valoración clinicoeconómica de un servicio de medicina interna-infecciosas en un hospital general universitario (2005-6).

OBJECTIVES: Comparative study in patients with infectious diseases admitted to a specialized Internal Medicine-Infectious Diseases Department (IMID) versus those admitted to other medical departments in a university general hospital, investigating quality and cost-effectiveness. PATIENTS AND METHODS: Analysis of patients in 10 principle diagnosis-related groups (DRGs) of infectious diseases admitted to the IMID were compared to those admitted to other medical departments (2005-2006). The DRG were divided in 4 main groups: respiratory infections (DGR 88, 89, 90, 540), urinary infections (DRG 320, 321), sepsis (DRG 416, 584), and skin infections (DRG 277, 278). For each group, quality variables (mortality and readmission rate), efficacy variables (mean hospital stay and mean DRG-based cost per patient) and complexity variables (case mix, relative weight, and functional index) were analyzed. RESULTS: 542 patients included in the 10 main infectious disease DRGs were admitted to IMID and 2404 to other medical departments. After adjusting for DRG case mix (case mix 0.99 for IMID and 0.89 for others), mean hospital stay (5.11 days vs. 7.65 days), mortality (3.5% vs. 7.9%) and mean DRG-based economic cost per patient (1521euro/patient vs. 2952euro/patient) was significantly lower in the group of patients hospitalized in IMID than the group in other medical departments (p<0.05). The readmission rate was similar in the 2 groups (5.5% and 6.5%, respectively). The results per each DRG group were similar to the overall results. CONCLUSIONS: For a similar case mix, hospitalization in IMID departments had a positive influence on the variables analyzed as compared to hospitalization in other departments, with a shorter mean stay, lower mortality, and lower mean DRG-based economic cost per patient. Creation and development of IMID departments should be an essential objective to improve healthcare quality and respond to social demands.

Valoración clinicoeconómica de un servicio de medicina interna-infecciosas en un hospital general universitario (2005–6) / Clinical and economic analysis of an internal medicine-infectious disease department at a university general hospital (2005–2006)

Objetivos: estudio comparativo con otros servicios médicos (SM) de la influencia de un servicio de medicina interna-infecciosas (SMIF) en la asistencia a pacientes ingresados con patología infecciosa en un hospital general universitario. Pacientes y métodos: análisis de los 10 principales grupos relacionados diagnósticos (GRD) de los pacientes ingresados en SMIF (2005–2006) y comparación con otros SM. Los GRD se han clasificado en 4 grupos: infecciones pulmonares; infecciones renales; sepsis, y celulitis. Para cada grupo de GRD se han valorado marcadores de calidad (índice de mortalidad y número de reingresos), marcadores de eficacia (estancia media y coste medio del GRD/paciente) e índices de complejidad (índice casuística [mix], peso relativo e índice de funcionamiento).Resultados: en el SMIF ingresaron 542 pacientes incluidos en los 10 principales GRD elegidos y 2.404 en los SM. Para un índice casuística de complejidad sin diferencias estadísticas (SMIF: 0,99 y SM: 0,89), la estancia media (5,1 frente a 7,6 días), la mortalidad (3,5 frente a 7,9%) y los costes medios por GRD (1.521 frente a 2.952 ¿ GRD/paciente) fueron significativamente menores en el SMIF (p<0,05). El índice de reingresos fue similar en ambos grupos (5,5 y 6,5%). Los datos desglosados por grupo de GRD fueron superponibles a los globales. Conclusiones: el SMIF influyó significativamente en la calidad asistencial (variables analizadas) de los pacientes con infecciones que precisaron hospitalización en relación con el resto de los SM, al lograr para un mismo índice de casuística (caso mix) una estancia media más corta, un menor coste medio del GRD y una disminución de la mortalidad. La creación o desarrollo de un SMIF debe ser un objetivo primordial para mejorar la atención a los usuarios y satisfacer las demandas sociales (AU)

Objectives: Comparative study in patients with infectious diseases admitted to a specialized Internal Medicine-Infectious Diseases Department (IMID) versus those admitted to other medical departments in a university general hospital, investigating quality and cost-effectiveness. Patients and methods: Analysis of patients in 10 principle diagnosis-related groups (DRGs) of infectious diseases admitted to the IMID were compared to those admitted to other medical departments (2005–2006). The DRG were divided in 4 main groups: respiratory infections (DGR 88, 89, 90, 540), urinary infections (DRG 320, 321), sepsis (DRG 416, 584), and skin infections (DRG 277, 278). For each group, quality variables (mortality and readmission rate), efficacy variables (mean hospital stay and mean DRG-based cost per patient) and complexity variables (case mix, relative weight, and functional index) were analyzed. Results: 542 patients included in the 10 main infectious disease DRGs were admitted to IMID and 2404 to other medical departments. After adjusting for DRG case mix (case mix 0.99 for IMID and 0.89 for others), mean hospital stay (5.11 days vs. 7.65 days), mortality (3.5% vs. 7.9%) and mean DRG-based economic cost per patient (1521¿/patient vs. 2952¿/patient) was significantly lower in the group of patients hospitalized in IMID than the group in other medical departments (p<0.05). The readmission rate was similar in the 2 groups (5.5% and 6.5%, respectively). The results per each DRG group were similar to the overall results. Conclusions: For a similar case mix, hospitalization in IMID departments had a positive influence on the variables analyzed as compared to hospitalization in other departments, with a shorter mean stay, lower mortality, and lower mean DRG-based economic cost per patient. Creation and development of IMID departments should be an essential objective to improve healthcare quality and respond to social demands (AU)