Perfil y evolución de pacientes crónicos complejos en una unidad de subagudos
Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ub...
Ausführliche Beschreibung
Autor*in: |
Neus Gual [verfasserIn] Anna Yuste Font [verfasserIn] Belen Enfedaque Montes [verfasserIn] Carles Blay Pueyo [verfasserIn] Remedios MartÃn Ãlvarez [verfasserIn] Marco Inzitari [verfasserIn] |
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E-Artikel |
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Sprache: |
Spanisch |
Erschienen: |
2017 |
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Übergeordnetes Werk: |
In: Atención Primaria - Elsevier, 2015, 49(2017), 9, Seite 510-517 |
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Übergeordnetes Werk: |
volume:49 ; year:2017 ; number:9 ; pages:510-517 |
Links: |
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DOI / URN: |
10.1016/j.aprim.2016.11.010 |
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Katalog-ID: |
DOAJ038001381 |
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520 | |a Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality | ||
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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 evolución de pacientes crónicos 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 pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención 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 evolución de pacientes crónicos 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 pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención 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 evolución de pacientes crónicos 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 pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención 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 evolución de pacientes crónicos 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 pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención 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 evolución de pacientes crónicos 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 pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención 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 |
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<?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 evolución de pacientes crónicos 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 pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. 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Perfil y evolución de pacientes crónicos complejos en una unidad de subagudos |
abstract |
Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality |
abstractGer |
Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality |
abstract_unstemmed |
Resumen: Objetivo: Para mejorar el manejo de pacientes pluripatológicos, en Cataluña se ha promovido la identificación como paciente crónico complejo (PCC) o con enfermedad crónica avanzada (MACA). Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. Palabras clave: Cronicidad, Multimorbilidad, Subagudos, Atención intermedia, Reingresos, Mortalidad, Keywords: Chronicity, Multimorbidity, Subacute care unit, Intermediate care, Readmissions, Mortality |
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Perfil y evolución de pacientes crónicos complejos en una unidad de subagudos |
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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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Anna Yuste Font Belen Enfedaque Montes Carles Blay Pueyo Remedios MartÃn Ãlvarez Marco Inzitari |
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Anna Yuste Font Belen Enfedaque Montes Carles Blay Pueyo Remedios MartÃn Ãlvarez Marco Inzitari |
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Ante descompensaciones se promueve el ingreso de estos pacientes en unidades de subagudos (SG) ubicadas en hospitales de atención intermedia y especializadas en geriatrÃa, como alternativa al hospital de agudos. Queremos evaluar los resultados del ingreso de PCC/MACA en SG. Diseño: Estudio cuantitativo descriptivo-comparativo, transversal. Emplazamiento: Unidad de subagudos de un hospital de atención intermedia. Participantes: Pacientes ingresados consecutivamente en SG durante 6 meses. Mediciones principales: Comparamos caracterÃsticas basales (datos demográficos, clÃnicos y de valoración geriátrica integral), resultados al alta y a 30 dÃas post-alta entre pacientes identificados como PCC/MACA vs otros pacientes. Resultados: De 244 pacientes (promedio edad ± DE = 85,6 ± 7,5; 65,6% mujeres), 91 (37,3%) eran PCC/MACA (PCC = 79,1%, MACA = 20,9%). Estos, comparado con los no identificados, presentaban mayor comorbilidad (Charlson = 3,2 ± 1,8 vs 2,0; p = 0,001) y polifarmacia (9,5 ± 3,7 fármacos vs 8,1 ± 3,8, p = 0,009). Al alta, el retorno al domicilio habitual y la mortalidad fueron comparables. PCC/MACA tuvieron mayor mortalidad sumando los 30 dÃas post-alta (15,4% vs 8%; p = 0,010); en un análisis multivariable, la identificación PCC/MACA (p = 0,006) y demencia (p = 0,004) se asociaba a mayor mortalidad. A pesar de que PCC/MACA reingresaban más a 30 dÃas (18,7% vs 10,5%; p = 0,014), en el análisis multivariable las únicas 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 más reingresos a 30 dÃas, posiblemente por su comorbilidad y polimedicación. 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 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. 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