Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos

Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Neus Gual [verfasserIn] Anna Yuste Font [verfasserIn] Belen Enfedaque Montes [verfasserIn] Carles Blay Pueyo [verfasserIn] Remedios MartÃn Ãlvarez [verfasserIn] Marco Inzitari [verfasserIn]

Format:	E-Artikel
Sprache:	Spanisch

Erschienen:	2017

Übergeordnetes Werk:	In: Atención Primaria - Elsevier, 2015, 49(2017), 9, Seite 510-517
Übergeordnetes Werk:	volume:49 ; year:2017 ; number:9 ; pages:510-517

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1016/j.aprim.2016.11.010

Katalog-ID:	DOAJ038001381

Internformat


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520			\|a Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality
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allfields	10.1016/j.aprim.2016.11.010 doi (DE-627)DOAJ038001381 (DE-599)DOAJfa99cc48ed644c389ff16c4d81c13ba4 DE-627 ger DE-627 rakwb spa R5-920 Neus Gual verfasserin aut Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality Medicine (General) Anna Yuste Font verfasserin aut Belen Enfedaque Montes verfasserin aut Carles Blay Pueyo verfasserin aut Remedios MartÃn Ãlvarez verfasserin aut Marco Inzitari verfasserin aut In Atención Primaria Elsevier, 2015 49(2017), 9, Seite 510-517 (DE-627)373325843 (DE-600)2125978-1 15781275 nnns volume:49 year:2017 number:9 pages:510-517 https://doi.org/10.1016/j.aprim.2016.11.010 kostenfrei https://doaj.org/article/fa99cc48ed644c389ff16c4d81c13ba4 kostenfrei http://www.sciencedirect.com/science/article/pii/S0212656716302803 kostenfrei https://doaj.org/toc/0212-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 49 2017 9 510-517
spelling	10.1016/j.aprim.2016.11.010 doi (DE-627)DOAJ038001381 (DE-599)DOAJfa99cc48ed644c389ff16c4d81c13ba4 DE-627 ger DE-627 rakwb spa R5-920 Neus Gual verfasserin aut Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality Medicine (General) Anna Yuste Font verfasserin aut Belen Enfedaque Montes verfasserin aut Carles Blay Pueyo verfasserin aut Remedios MartÃn Ãlvarez verfasserin aut Marco Inzitari verfasserin aut In Atención Primaria Elsevier, 2015 49(2017), 9, Seite 510-517 (DE-627)373325843 (DE-600)2125978-1 15781275 nnns volume:49 year:2017 number:9 pages:510-517 https://doi.org/10.1016/j.aprim.2016.11.010 kostenfrei https://doaj.org/article/fa99cc48ed644c389ff16c4d81c13ba4 kostenfrei http://www.sciencedirect.com/science/article/pii/S0212656716302803 kostenfrei https://doaj.org/toc/0212-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 49 2017 9 510-517
allfields_unstemmed	10.1016/j.aprim.2016.11.010 doi (DE-627)DOAJ038001381 (DE-599)DOAJfa99cc48ed644c389ff16c4d81c13ba4 DE-627 ger DE-627 rakwb spa R5-920 Neus Gual verfasserin aut Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality Medicine (General) Anna Yuste Font verfasserin aut Belen Enfedaque Montes verfasserin aut Carles Blay Pueyo verfasserin aut Remedios MartÃn Ãlvarez verfasserin aut Marco Inzitari verfasserin aut In Atención Primaria Elsevier, 2015 49(2017), 9, Seite 510-517 (DE-627)373325843 (DE-600)2125978-1 15781275 nnns volume:49 year:2017 number:9 pages:510-517 https://doi.org/10.1016/j.aprim.2016.11.010 kostenfrei https://doaj.org/article/fa99cc48ed644c389ff16c4d81c13ba4 kostenfrei http://www.sciencedirect.com/science/article/pii/S0212656716302803 kostenfrei https://doaj.org/toc/0212-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 49 2017 9 510-517
allfieldsGer	10.1016/j.aprim.2016.11.010 doi (DE-627)DOAJ038001381 (DE-599)DOAJfa99cc48ed644c389ff16c4d81c13ba4 DE-627 ger DE-627 rakwb spa R5-920 Neus Gual verfasserin aut Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality Medicine (General) Anna Yuste Font verfasserin aut Belen Enfedaque Montes verfasserin aut Carles Blay Pueyo verfasserin aut Remedios MartÃn Ãlvarez verfasserin aut Marco Inzitari verfasserin aut In Atención Primaria Elsevier, 2015 49(2017), 9, Seite 510-517 (DE-627)373325843 (DE-600)2125978-1 15781275 nnns volume:49 year:2017 number:9 pages:510-517 https://doi.org/10.1016/j.aprim.2016.11.010 kostenfrei https://doaj.org/article/fa99cc48ed644c389ff16c4d81c13ba4 kostenfrei http://www.sciencedirect.com/science/article/pii/S0212656716302803 kostenfrei https://doaj.org/toc/0212-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 49 2017 9 510-517
allfieldsSound	10.1016/j.aprim.2016.11.010 doi (DE-627)DOAJ038001381 (DE-599)DOAJfa99cc48ed644c389ff16c4d81c13ba4 DE-627 ger DE-627 rakwb spa R5-920 Neus Gual verfasserin aut Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality Medicine (General) Anna Yuste Font verfasserin aut Belen Enfedaque Montes verfasserin aut Carles Blay Pueyo verfasserin aut Remedios MartÃn Ãlvarez verfasserin aut Marco Inzitari verfasserin aut In Atención Primaria Elsevier, 2015 49(2017), 9, Seite 510-517 (DE-627)373325843 (DE-600)2125978-1 15781275 nnns volume:49 year:2017 number:9 pages:510-517 https://doi.org/10.1016/j.aprim.2016.11.010 kostenfrei https://doaj.org/article/fa99cc48ed644c389ff16c4d81c13ba4 kostenfrei http://www.sciencedirect.com/science/article/pii/S0212656716302803 kostenfrei https://doaj.org/toc/0212-6567 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 49 2017 9 510-517
language	Spanish
source	In Atención Primaria 49(2017), 9, Seite 510-517 volume:49 year:2017 number:9 pages:510-517
sourceStr	In Atención Primaria 49(2017), 9, Seite 510-517 volume:49 year:2017 number:9 pages:510-517
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Medicine (General)
isfreeaccess_bool	true
container_title	Atención Primaria
authorswithroles_txt_mv	Neus Gual @@aut@@ Anna Yuste Font @@aut@@ Belen Enfedaque Montes @@aut@@ Carles Blay Pueyo @@aut@@ Remedios MartÃn Ãlvarez @@aut@@ Marco Inzitari @@aut@@
publishDateDaySort_date	2017-01-01T00:00:00Z
hierarchy_top_id	373325843
id	DOAJ038001381
language_de	spanisch
fullrecord	<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">DOAJ038001381</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230308014627.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230227s2017 xx \|\|\|\|\|o 00\| \|\|spa c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1016/j.aprim.2016.11.010</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ038001381</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJfa99cc48ed644c389ff16c4d81c13ba4</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">spa</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">R5-920</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Neus Gual</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2017</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Medicine (General)</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Anna Yuste Font</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Belen Enfedaque Montes</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Carles Blay Pueyo</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Remedios MartÃn Ãlvarez</subfield><subfield code="e">verfasserin</subfield><subfield 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callnumber-first	R - Medicine
author	Neus Gual
spellingShingle	Neus Gual misc R5-920 misc Medicine (General) Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos
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topic_title	R5-920 Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos
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title	Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos
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title_full	Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos
author_sort	Neus Gual
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author_browse	Neus Gual Anna Yuste Font Belen Enfedaque Montes Carles Blay Pueyo Remedios MartÃn Ãlvarez Marco Inzitari
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class	R5-920
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author-letter	Neus Gual
doi_str_mv	10.1016/j.aprim.2016.11.010
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title_sort	perfil y evoluciã³n de pacientes crã³nicos complejos en una unidad de subagudos
callnumber	R5-920
title_auth	Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos
abstract	Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality
abstractGer	Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality
abstract_unstemmed	Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatolÃ³gicos, en CataluÃ±a se ha promovido la identificaciÃ³n como paciente crÃ³nico complejo (PCC) o con enfermedad crÃ³nica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality
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container_issue	9
title_short	Perfil y evoluciÃ³n de pacientes crÃ³nicos complejos en una unidad de subagudos
url	https://doi.org/10.1016/j.aprim.2016.11.010 https://doaj.org/article/fa99cc48ed644c389ff16c4d81c13ba4 http://www.sciencedirect.com/science/article/pii/S0212656716302803 https://doaj.org/toc/0212-6567
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author2	Anna Yuste Font Belen Enfedaque Montes Carles Blay Pueyo Remedios MartÃn Ãlvarez Marco Inzitari
author2Str	Anna Yuste Font Belen Enfedaque Montes Carles Blay Pueyo Remedios MartÃn Ãlvarez Marco Inzitari
ppnlink	373325843
callnumber-subject	R - General Medicine
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doi_str	10.1016/j.aprim.2016.11.010
callnumber-a	R5-920
up_date	2024-07-03T15:25:11.088Z
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Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atenciÃ³n intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. DiseÃ±o: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atenciÃ³n intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6Â meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demogrÃ¡ficos, clÃnicos y de valoraciÃ³n geriÃ¡trica integral), resultados al alta y a 30Â dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edadÂ Â±Â DEÂ =Â 85,6Â Â±Â 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (CharlsonÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) y polifarmacia (9,5Â Â±Â 3,7 fÃ¡rmacos vs 8,1Â Â±Â 3,8, pÂ =Â 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30Â dÃas post-alta (15,4% vs 8%; pÂ =Â 0,010); en un anÃ¡lisis multivariable, la identificaciÃ³n PCC/MACA (pÂ =Â 0,006) y demencia (pÂ =Â 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban mÃ¡s a 30Â dÃas (18,7% vs 10,5%; pÂ =Â 0,014), en el anÃ¡lisis multivariable las Ãºnicas variables asociadas independientemente a reingresos fueron sexo masculino, polifarmacia e insuficiencia cardiaca. Conclusiones: A pesar de mayor comorbilidad y polifarmacia, los resultados de PCC/MACA al alta de SG fueron comparables con los otros pacientes, aunque experimentaron mÃ¡s reingresos a 30Â dÃas, posiblemente por su comorbilidad y polimedicaciÃ³n. Abstract: 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 6Â months. Main measurements: We compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30Â days post-discharge between PCC/MACA patients versus other patients. Results: Of 244 patients (mean ageÂ Â±Â SDÂ =85,6Â Â±Â 7,5; 65.6%Â women), 91 (37,3%) were PCC/MACA (PCCÂ =Â 79,1%, MACAÂ =Â 20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson indexÂ =Â 3,2Â Â±Â 1,8 vs 2,0; pÂ =Â 0,001) and polypharmacy (9,5Â Â±Â 3,7 drugs vs 8,1Â Â±Â 3,8; pÂ =Â 0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30Â day post-discharge (15,4% vs 8%; pÂ =Â 0,010). In a multi-variable analysis, PCC/MACA identification (pÂ =Â 0,006), as well as a history of dementia (pÂ =Â 0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30Â day (18,7% vs 10,5%; pÂ =Â 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 30Â days, possibly due to comorbidity and polypharmacy. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, AtenciÃ³n intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Medicine (General)</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Anna Yuste Font</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Belen Enfedaque Montes</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Carles Blay Pueyo</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Remedios MartÃn Ãlvarez</subfield><subfield code="e">verfasserin</subfield><subfield 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score	7.3988714

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