TY - JOUR
T1 - Profile and evolution of chronic complex patients in a subacute unit
AU - Gual, Neus
AU - Yuste Font, Anna
AU - Enfedaque Montes, Belen
AU - Blay Pueyo, Carles
AU - Martín Álvarez, Remedios
AU - Inzitari, Marco
PY - 2017/11/1
Y1 - 2017/11/1
N2 - © 2017 Elsevier España, S.L.U. Objective To improve the management of geriatric pluripathologic patients in Catalonia, the identification of chronic complex patient (PCC) or patients with advanced chronic disease (MACA) has been promoted. Patients with exacerbated chronic diseases are promoted to be admitted in subacute units (SG) located in intermediate hospitals and specialized in geriatric care, as an alternative to acute hospital. The results of the care process in patients identified as PCC/MACA in SG have not been evaluated. Design Descriptive-comparative, cross-sectional, and quantitative study. Location SG located in intermediate care hospital. Participants Consecutive patients admitted in the SG during 6 months. Main measurements We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30 days post-discharge between PCC/MACA patients versus other patients. Results Of 244 patients (mean age ± SD =85,6 ± 7,5; 65.6% women), 91 (37,3%) were PCC/MACA (PCC = 79,1%, MACA = 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson index = 3,2 ± 1,8 vs 2,0; p = 0,001) and polypharmacy (9,5 ± 3,7 drugs vs 8,1 ± 3,8; p = 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30 day post-discharge (15,4% vs 8%; p = 0,010). In a multi-variable analysis, PCC/MACA identification (p = 0,006), as well as a history of dementia (p = 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30 day (18,7% vs 10,5%; p = 0,014), in the multivariable analyses, only male, polypharmacy, and heart failure were independently associated to readmission. Conclusions Despite having more comorbidity and polypharmacy, the outcomes of patients identified as PCC/MACA at discharge of SG, were comparable with other patients, although they experienced more readmissions within 30 days, possibly due to comorbidity and polypharmacy.
AB - © 2017 Elsevier España, S.L.U. Objective To improve the management of geriatric pluripathologic patients in Catalonia, the identification of chronic complex patient (PCC) or patients with advanced chronic disease (MACA) has been promoted. Patients with exacerbated chronic diseases are promoted to be admitted in subacute units (SG) located in intermediate hospitals and specialized in geriatric care, as an alternative to acute hospital. The results of the care process in patients identified as PCC/MACA in SG have not been evaluated. Design Descriptive-comparative, cross-sectional, and quantitative study. Location SG located in intermediate care hospital. Participants Consecutive patients admitted in the SG during 6 months. Main measurements We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30 days post-discharge between PCC/MACA patients versus other patients. Results Of 244 patients (mean age ± SD =85,6 ± 7,5; 65.6% women), 91 (37,3%) were PCC/MACA (PCC = 79,1%, MACA = 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson index = 3,2 ± 1,8 vs 2,0; p = 0,001) and polypharmacy (9,5 ± 3,7 drugs vs 8,1 ± 3,8; p = 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30 day post-discharge (15,4% vs 8%; p = 0,010). In a multi-variable analysis, PCC/MACA identification (p = 0,006), as well as a history of dementia (p = 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30 day (18,7% vs 10,5%; p = 0,014), in the multivariable analyses, only male, polypharmacy, and heart failure were independently associated to readmission. Conclusions Despite having more comorbidity and polypharmacy, the outcomes of patients identified as PCC/MACA at discharge of SG, were comparable with other patients, although they experienced more readmissions within 30 days, possibly due to comorbidity and polypharmacy.
KW - Chronicity
KW - Intermediate care
KW - Mortality
KW - Multimorbidity
KW - Readmissions
KW - Subacute care unit
UR - https://ddd.uab.cat/record/217130
U2 - https://doi.org/10.1016/j.aprim.2016.11.010
DO - https://doi.org/10.1016/j.aprim.2016.11.010
M3 - Article
VL - 49
SP - 510
EP - 517
JO - Atencion Primaria
JF - Atencion Primaria
SN - 0212-6567
IS - 9
ER -