1
|
Suarez-Dono J, Novo-Veleiro I, Gude-Sampedro F, Marinho R, Xavier-Pires S, Rocha D, Araújo-Correia J, Moreira C, Beires F, Pérez D, David F, Vasco-Barreto J, Del Corral-Beamonte E, Piñeiro-Fernández JC, Casariego-Vales E, Diez-Manglano J, Pose-Reino A. Atrial fibrillation as a new prognosis factor in chronic patients after hospitalization: the CHRONIBERIA index. Sci Rep 2023; 13:4068. [PMID: 36906719 PMCID: PMC10008559 DOI: 10.1038/s41598-023-30610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023] Open
Abstract
A collaborative project in different areas of Spain and Portugal was designed to find out the variables that influence the mortality after discharge and develop a prognostic model adapted to the current healthcare needs of chronic patients in an internal medicine ward. Inclusion criteria were being admitted to an Internal Medicine department and at least one chronic disease. Patients' physical dependence was measured through Barthel index (BI). Pfeiffer test (PT) was used to establish cognitive status. We conducted logistic regression and Cox proportional hazard models to analyze the influence of those variables on one-year mortality. We also developed an external validation once decided the variables included in the index. We enrolled 1406 patients. Mean age was 79.5 (SD = 11.5) and females were 56.5%. After the follow-up period, 514 patients (36.6%) died. Five variables were identified as significantly associated with 1 year mortality: age, being male, lower BI punctuation, neoplasia and atrial fibrillation. A model with such variables was created to estimate one-year mortality risk, leading to the CHRONIBERIA. A ROC curve was made to determine the reliability of this index when applied to the global sample. An AUC of 0.72 (0.7-0.75) was obtained. The external validation of the index was successful and showed an AUC of 0.73 (0.67-0.79). Atrial fibrillation along with an advanced age, being male, low BI score, or an active neoplasia in chronic patients could be critical to identify high risk multiple chronic conditions patients. Together, these variables constitute the new CHRONIBERIA index.
Collapse
Affiliation(s)
- Javier Suarez-Dono
- Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela y Barbanza, School of Medicine, University of Santiago de Compostela, Rua da Choupana S/N, 15706, Santiago de Compostela. A Coruña, Spain
| | - Ignacio Novo-Veleiro
- Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela y Barbanza, School of Medicine, University of Santiago de Compostela, Rua da Choupana S/N, 15706, Santiago de Compostela. A Coruña, Spain.
| | - Francisco Gude-Sampedro
- Epidemiology Unit, Complexo Hospitalario Universitario de Santiago de Compostela y Barbanza, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ricardo Marinho
- Internal Medicine Department, Santo António Hospital - Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Sara Xavier-Pires
- Internal Medicine Department, Santo António Hospital - Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Diana Rocha
- Internal Medicine Department, Santo António Hospital - Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - João Araújo-Correia
- Internal Medicine Department, Santo António Hospital - Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Multidisciplinary Biomedical Research Unit (UMIB), Abel Salazar Biomedical Science Institute (ICBAS), Porto, Portugal
| | - Cecília Moreira
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Francisca Beires
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Danay Pérez
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Filipa David
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - J Vasco-Barreto
- Internal Medicine Service, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal.,Abel Salazar Biomedical Science Institute (ICBAS), Porto, Portugal
| | - Esther Del Corral-Beamonte
- Internal Medicine Department. Hospital Royo Villanova, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | | | | | - Jesús Diez-Manglano
- Internal Medicine Department. Hospital Royo Villanova, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Antonio Pose-Reino
- Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela y Barbanza, School of Medicine, University of Santiago de Compostela, Rua da Choupana S/N, 15706, Santiago de Compostela. A Coruña, Spain.
| |
Collapse
|
2
|
Casariego-Vales E, Palencia-Vizcarra R, Bolaño J, Cámera L, Valdez P. Executive summary on the use of telemedicine in the hospital setting: Recommendations from the International Forum on Internal Medicine. Rev Clin Esp 2023; 223:50-55. [PMID: 35618572 DOI: 10.1016/j.rceng.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 02/01/2023]
Abstract
The implementation of telemedicine as another tool for patient care in the hospital setting is a challenge for any healthcare system. Given the difficulties and limitations, the International Forum on Internal Medicine (FIMI, for its initials in Spanish) has sponsored this consensus document with 20 scientific societies from 17 countries in Europe and the Americas. The aim was to propose a general framework that allows for the development and implementation of telemedicine in hospital clinical care that would be useful to FIMI member countries. The document we present includes recommendations from the FIMI in its executive summary that intend to guarantee effective, safe, efficient, sustainable, and proportional healthcare interventions based on the best scientific evidence available. The authors believe that this document must be updated within a maximum period of two years.
Collapse
Affiliation(s)
- E Casariego-Vales
- Sociedad Española de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | | | - J Bolaño
- Sociedad Argentina de Medicina, Universidad Nacional del Nordeste, Hospital Perrando, Resistencia Chaco, Argentina
| | - L Cámera
- Sociedad Argentina de Medicina, Universidad de Buenos Aires, Hospital Italiano de Buenos Aires, Caba, Argentina
| | - P Valdez
- Sociedad Argentina de Medicina, Universidad de Buenos Aires, Universidad Nacional de La Matanza, Hospital Vélez Sarsfield, Caba, Argentina
| | | |
Collapse
|
3
|
Cerqueiro-González J, González-Franco Á, Carrascosa-García S, Soler-Rangel L, Ruiz-Laiglesia F, Epelde-Gonzalo F, Dávila-Ramos M, Casado-Cerrada J, Casariego-Vales E, Manzano L. Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardíaca y fracción de eyección preservada: Programa UMIPIC. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
4
|
Piñeiro-Fernández JC, Fernández-Rial Á, Suárez-Gil R, Martínez-García M, García-Trincado B, Suárez-Piñera A, Pértega-Díaz S, Casariego-Vales E. Evaluation of a patient-centered integrated care program for individuals with frequent hospital readmissions and multimorbidity. Intern Emerg Med 2022; 17:789-797. [PMID: 34714486 DOI: 10.1007/s11739-021-02876-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
Managing patients with multimorbidity and frequent hospital readmissions is a challenge. Integrated care programs that consider their needs and allow for personalized care are necessary for their early identification and management. This work aims to describe these patients' clinical characteristics and evaluate a program designed to reducing readmissions. This prospective study analyzed all patients with ≥ 3 admissions to a medical department in the previous year who were included in the Internal Medicine Department chronic care program at the Lucus Augusti University Hospital (Lugo, Spain) between April 1, 2019 and April 30, 2021. A multidimensional assessment, personalized care plan, and proactive follow-up with a case manager nurse were provided via an advanced hospital system. Clinical and demographic variables and data on healthcare system use were analyzed at 6 and 12 months before and after inclusion. Descriptive and survival analyses were performed. One hundred sixty-one patients were included. Program participants were elderly (mean 81.4 (SD 11) years), had multimorbidity (10.2 (3) chronic diseases) and polypharmacy (10.6 (3.5) drugs), frequently used the healthcare system, and were highly complex. Most were included for heart failure. The program led to significant reductions in admissions and emergency department visits (p = .0001). A total of 44.7% patients died within 1 year. The PROFUND Index showed good predictive ability (p = .013), with high values associated with mortality (RR 1.15, p = .001). Patients with frequent hospital readmissions are highly complex and need special care. A personalized integrated care program reduced admissions and allowed for individualized decision-making.
Collapse
Affiliation(s)
- Juan Carlos Piñeiro-Fernández
- Department of Internal Medicine, Lucus Augusti University Hospital, SERGAS, 1 Ulises Romero Street, 27003, Lugo, Spain.
| | - Álvaro Fernández-Rial
- Department of Internal Medicine, Lucus Augusti University Hospital, SERGAS, 1 Ulises Romero Street, 27003, Lugo, Spain
| | - Roi Suárez-Gil
- Department of Internal Medicine, Lucus Augusti University Hospital, SERGAS, 1 Ulises Romero Street, 27003, Lugo, Spain
| | - Mónica Martínez-García
- Case Manager Nurse, Medical Day Hospital, Lucus Augusti University Hospital, SERGAS, Lugo, Spain
| | - Beatriz García-Trincado
- Department of Internal Medicine, Lucus Augusti University Hospital, SERGAS, 1 Ulises Romero Street, 27003, Lugo, Spain
| | - Adrián Suárez-Piñera
- Department of Internal Medicine, Lucus Augusti University Hospital, SERGAS, 1 Ulises Romero Street, 27003, Lugo, Spain
| | - Sonia Pértega-Díaz
- Clinical Epidemiology and Biostatistics Research Group, A Coruña Biomedical Research Institute (INIBIC), University of A Coruña, A Coruña, Spain
| | - Emilio Casariego-Vales
- Department of Internal Medicine, Lucus Augusti University Hospital, SERGAS, 1 Ulises Romero Street, 27003, Lugo, Spain
| |
Collapse
|
5
|
Cerqueiro-González J, González-Franco Á, Carrascosa-García S, Soler-Rangel L, Ruiz-Laiglesia F, Epelde-Gonzalo F, Dávila-Ramos M, Casado-Cerrada J, Casariego-Vales E, Manzano L. Benefits of a comprehensive care model in patients with heart failure and preserved ejection fraction: The UMIPIC program. Rev Clin Esp 2022; 222:339-347. [DOI: 10.1016/j.rceng.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/14/2021] [Indexed: 01/10/2023]
|
6
|
Casariego-Vales E, Blanco-López R, Rosón-Calvo B, Suárez-Gil R, Santos-Guerra F, Dobao-Feijoo MJ, Ares-Rico R, Bal-Alvaredo M. Efficacy of Telemedicine and Telemonitoring in At-Home Monitoring of Patients with COVID-19. J Clin Med 2021; 10:jcm10132893. [PMID: 34209725 PMCID: PMC8268946 DOI: 10.3390/jcm10132893] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 01/08/2023] Open
Abstract
Aim: this work aims to assess if telemedicine and telemonitoring are clinically useful and safe for at-home monitoring of Coronavirus disease 2019 (COVID-19) patients. Methods: This is a retrospective cohort study of all patients diagnosed with COVID-19 in Galicia (Northwestern Spain) between 26 December 2020 and 15 February 2021. The structured, proactive monitoring via telemonitoring (TELEA) of patients considered to be high-risk in the Lugo, A Mariña, and Monforte Healthcare Area (ASLAM) was evaluated compared to other models in the remaining healthcare areas of Galicia. Results: Of the 47,053 COVID-19 patients, 4384 (9.3%) were in ASLAM. Of them, 1187 (27.1%) were monitored via TELEA, and the rest (3197 in ASLAM and 42,669 in the rest of Galicia) were monitored via other methods. Patients monitored in ASLAM via TELEA were older, consulted in the emergency department less frequently (p = 0.05), were hospitalized less frequently (p < 0.01), had shorter hospital stays (p < 0.0001), and had a lower mortality rate in their first hospitalization (p = 0.03). No at-home life-threatening emergencies were recorded. Conclusions: these data suggest that, for COVID-19 patients, a care model involving proactive at-home monitoring with telemedicine and telemonitoring is associated with reduced pressure on hospital services and a lower mortality rate.
Collapse
Affiliation(s)
- Emilio Casariego-Vales
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.S.-G.); (M.B.-A.)
- Unidad Administrativa 3B, Lucus Augusti University Hospital, C/Dr. U. Romero, 1, 27003 Lugo, Spain
- Correspondence:
| | - Rosa Blanco-López
- Day Hospital Nursing, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.B.-L.); (M.J.D.-F.)
| | - Benigno Rosón-Calvo
- Subdirectorate General, Galician Health Service, Ministry of Health, Santiago de Compostela, 15703 A Coruña, Spain; (B.R.-C.); (F.S.-G.)
| | - Roi Suárez-Gil
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.S.-G.); (M.B.-A.)
| | - Fernando Santos-Guerra
- Subdirectorate General, Galician Health Service, Ministry of Health, Santiago de Compostela, 15703 A Coruña, Spain; (B.R.-C.); (F.S.-G.)
| | - María José Dobao-Feijoo
- Day Hospital Nursing, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.B.-L.); (M.J.D.-F.)
| | - Ramón Ares-Rico
- Management, Lugo Healthcare Area, A Mariña and Monforte de Lemos, Lucus Augusti University Hospital, 27003 Lugo, Spain;
| | - Mercedes Bal-Alvaredo
- Internal Medicine Department, Lucus Augusti University Hospital, 27003 Lugo, Spain; (R.S.-G.); (M.B.-A.)
| | | |
Collapse
|
7
|
Matesanz-Fernández M, Seoane-Pillado T, Iñiguez-Vázquez I, Suárez-Gil R, Pértega-Díaz S, Casariego-Vales E. Description of multimorbidity clusters of admitted patients in medical departments of a general hospital. Postgrad Med J 2021; 98:294-299. [PMID: 33547138 DOI: 10.1136/postgradmedj-2020-139361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We aim to identify patterns of disease clusters among inpatients of a general hospital and to describe the characteristics and evolution of each group. METHODS We used two data sets from the CMBD (Conjunto mínimo básico de datos - Minimum Basic Hospital Data Set (MBDS)) of the Lucus Augusti Hospital (Spain), hospitalisations and patients, realising a retrospective cohort study among the 74 220 patients discharged from the Medic Area between 01 January 2000 and 31 December 2015. We created multimorbidity clusters using multiple correspondence analysis. RESULTS We identified five clusters for both gender and age. Cluster 1: alcoholic liver disease, alcoholic dependency syndrome, lung and digestive tract malignant neoplasms (age under 50 years). Cluster 2: large intestine, prostate, breast and other malignant neoplasms, lymphoma and myeloma (age over 70, mostly males). Cluster 3: malnutrition, Parkinson disease and other mobility disorders, dementia and other mental health conditions (age over 80 years and mostly women). Cluster 4: atrial fibrillation/flutter, cardiac failure, chronic kidney failure and heart valve disease (age between 70-80 and mostly women). Cluster 5: hypertension/hypertensive heart disease, type 2 diabetes mellitus, ischaemic cardiomyopathy, dyslipidaemia, obesity and sleep apnea, including mostly men (age range 60-80). We assessed significant differences among the clusters when gender, age, number of chronic pathologies, number of rehospitalisations and mortality during the hospitalisation were assessed (p<0001 in all cases). CONCLUSIONS We identify for the first time in a hospital environment five clusters of disease combinations among the inpatients. These clusters contain several high-incidence diseases related to both age and gender that express their own evolution and clinical characteristics over time.
Collapse
Affiliation(s)
| | - Teresa Seoane-Pillado
- Área de Medicina Preventiva y Salud pública, Departamento de Ciencias de la Salud, Universidade da Coruña, A Coruña, Spain
| | | | - Roi Suárez-Gil
- Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Sonia Pértega-Díaz
- Unidad de Epidemiología Clínica y Bioestadística, Complexo Hospitalario Universitario A Coruña-Instituto de Investigación Biomédica, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | |
Collapse
|
8
|
Martínez-García M, Bal-Alvarado M, Santos Guerra F, Ares-Rico R, Suárez-Gil R, Rodríguez-Álvarez A, Pérez-López A, Casariego-Vales E, Fernández Rial Á, Rabuñal Rey R, Rodríguez Álvarez A, Pérez López A, Golpe Gómez R, Gil Mouce C, Suárez Ramírez N, Almuiña Simón C, José Cereijo Quinteiro M, Daporta Rodríguez L, Fernández Valdivieso E, Vázquez Fernández A, Barcia Losada A, García Martínez A, Portero Vázquez A, Trillo Dono N, Revilla Villegas C, Fernández Rodríguez R, García Armesto I, Giadas Piñeiro R, Rosa Rodríguez Macía A, Carballada González F, Núñez Orjales R, Martin Lázaro J, Alfredo González Guzmán L, Mar Abad García M, Gloria Álvarez Silveiro M, Carmen Coria Abel M, Díaz Sánchez J, Jesús Freire Regueiro M, María Casanova Quiñoá A, José Dobao Feijoo M, Luisa Fernández Rodríguez M, Rey Ponce Á, Monte Secades R, Jesús Pérez Taboada M, Sánchez Fernández R, Pérez Peña J, Pereira M, Conde Freire J. Monitoring of COVID-19 patients via telemedicine with telemonitoring. Rev Clin Esp 2020. [PMID: 32620311 PMCID: PMC7373001 DOI: 10.1016/j.rceng.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aim To asses if telemedicine with telemonitoring is a clinically useful and safe tool for monitoring patients with COVID-19. Methods A prospective observational study of patients with COVID-19 diagnosed via a positive PCR test who were considered high-risk and who were monitored with telemedicine and telemonitoring in the Lugo Healthcare Area between March 17th and April 17th, 2020, was conducted. Two groups of patients were included: those in outpatient monitoring from the beginning and those in outpatient monitoring following hospital discharge. Every patient completed a clinical questionnaire with his or her temperature once per day and oxygen saturation levels three times per day. Proactive monitoring was done by getting in touch with every patient at least once a day. Results A total of 313 patients (52.4% female) with a mean age of 60.9 (SD 15.9) years were included. Two patients refused to participate in the program. Finally, 224 were monitored from the beginning and 89 patients were monitored after discharged. In the first group, 38 (16.90%) were referred to the Emergency department on 43 occasions; 18 (8.03%) were hospitalized, and two died. There were no deaths or lifethreatening at home. Including the patients monitored after hospitalization, monitoring was performed in 304 cases. One patient was readmited (0.32%) and another left the program (0.32%). The mean time of monitoring was 11.64 (SD 3.58) days and 224 (73.68%) patients were discharged during the 30 days the study lasted. Conclusions Our data suggest that telemedicine with at-home telemonitoring, when used proactively, allows for clinically useful and safe monitoring of high-risk patients with COVID-19.
Collapse
|
9
|
Martínez-García M, Bal-Alvarado M, Santos Guerra F, Ares-Rico R, Suárez-Gil R, Rodríguez-Álvarez A, Pérez-López A, Casariego-Vales E. [Monitoring of COVID-19 patients by telemedicine with telemonitoring]. Rev Clin Esp 2020; 220:472-479. [PMID: 33994572 PMCID: PMC7274600 DOI: 10.1016/j.rce.2020.05.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/08/2023]
Abstract
Objetivo Evaluar si la telemedicina con telemonitorización es una herramienta clínicamente útil y segura para el seguimiento de pacientes con COVID-19. Métodos Estudio observacional prospectivo de los pacientes con diagnóstico de COVID-19 por PCR positiva y considerados de alto riesgo que se siguieron con telemedicina y telemonitorización en el Área Sanitaria de Lugo entre el 17 de marzo y el 17 de abril del 2020. Se incluyeron 2 grupos de pacientes: seguimiento ambulatorio desde el inicio y tras el alta hospitalaria. Cada paciente remitió un cuestionario clínico al día con su temperatura y saturación de oxígeno 3 veces al día. El seguimiento fue proactivo, contactando con todos los pacientes al menos una vez al día. Resultados Se incluyó a 313 pacientes (52,4% mujeres) con edad media 60,9 (DE 15,9) años. Otros 2 pacientes rehusaron entrar en el programa. Desde el inicio, se siguió ambulatoriamente a 224 pacientes y a 89 pacientes tras su alta hospitalaria. Entre los primeros, 38 (16,90%) se remitieron a Urgencias en 43 ocasiones con 18 (8,03%) ingresos y 2 fallecidos. En los domicilios no hubo fallecimientos ni urgencias vitales. Incluyendo a los pacientes tras hospitalización, el seguimiento se realizó en 304 casos. Un paciente reingresó (0,32%) y otro abandonó (0,32%). El tiempo medio de seguimiento fue 11,64 (DE 3,58) días y en los 30 días del estudio 224 (73,68%) pacientes fueron dados de alta. Conclusiones Nuestros datos sugieren que la telemedicina con telemonitorización domiciliaria, utilizada de forma proactiva, permite un seguimiento clínicamente útil y seguro en pacientes con COVID-19 de alto riesgo.
Collapse
Affiliation(s)
- M Martínez-García
- Hospital de Día de Procesos, Hospital Universitario Lucus Augusti, Lugo, España
| | - M Bal-Alvarado
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España
| | - F Santos Guerra
- Servicio de Gestión de Proyectos de Sistemas de Información, Servicio Gallego de Salud, Consejería de Sanidad, Santiago de Compostela, A Coruña, España
| | - R Ares-Rico
- Gerencia, Área Sanitaria de Lugo, A Mariña y Monforte de Lemos, Hospital Universitario Lucus Augusti, Lugo, España
| | - R Suárez-Gil
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España
| | - A Rodríguez-Álvarez
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España
| | - A Pérez-López
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España
| | - E Casariego-Vales
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España
| | | | | |
Collapse
|
10
|
Affiliation(s)
- E Casariego-Vales
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España.
| | - L A Cámera
- Programa de Medicina Geriátrica, Servicio de Clínica y Medicina Interna, Hospital Italiano, Buenos Aires, Argentina
| |
Collapse
|
11
|
Zapatero-Gaviria A, Javier Elola-Somoza F, Casariego-Vales E, Fernandez-Perez C, Gomez-Huelgas R, Bernal JL, Barba-Martín R. RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes. Int J Qual Health Care 2017; 29:507-511. [PMID: 28541515 DOI: 10.1093/intqhc/mzx055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 05/05/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. Design Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. Setting Spanish National Health Service. Participants One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). Main Outcome Measures IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. Results Greater hospital complexity was associated with longer average length of stays (r: 0.42; P < 0.001). Crude in-hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes. Conclusions We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | - José Luis Bernal
- Control Management Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Barba-Martín
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| |
Collapse
|
12
|
Casariego-Vales E, Zapatero-Gaviria A, Elola-Somoza FJ. The Internal Medicine of the 21st century: Organizational and operational standards. Rev Clin Esp 2017; 217:526-533. [PMID: 28734479 DOI: 10.1016/j.rce.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/16/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years.
Collapse
Affiliation(s)
- E Casariego-Vales
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España.
| | - A Zapatero-Gaviria
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - F J Elola-Somoza
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, España
| | | |
Collapse
|
13
|
Roldán I, Marín F, Roldán I, Marín F, Tello-Montoliu A, Roldán V, Anguita M, Ruiz Nodar JM, Íñiguez A, González Juanatey JR, Rodríguez Padial L, Badimón L, Mateo J, Vicente V, Gallego Culleré J, Masjuan J, González-Armengol JJ, Marín-Martínez A, Coll-Vinent i Puig B, Casariego-Vales E, Llisterri-Caro JL, Polo-García J, Rodríguez-Roca GC. En el camino de un mejor uso de los anticoagulantes en la fibrilación auricular no valvular. Propuesta de modificación del posicionamiento terapéutico UT/V4/23122013. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
14
|
Matesanz-Fernández M, Monte-Secades R, Íñiguez-Vázquez I, Rubal-Bran D, Guerrero-Sande H, Casariego-Vales E. Characteristics and temporal pattern of the readmissions of patients with multiple hospital admissions in the medical departments of a general hospital. Eur J Intern Med 2015; 26:776-81. [PMID: 26604106 DOI: 10.1016/j.ejim.2015.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/22/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with multiple hospital admissions represent a small percentage of total hospitalizations but result in a considerable proportion of the healthcare expenditure. There are no studies that have analyzed their long-term clinical evolution. OBJECTIVES To study the characteristics, temporal patterns of readmissions and clinical evolution of patients with multiple hospital admission in the long term. METHODS A retrospective study was conducted of all hospital admissions in the medical area of the Hospital of Lugo (Spain) between January 1, 2000 and December 31, 2012, based on data from the center's minimum basic data set. RESULTS A total of 139,249 hospital admissions for 62,515 patients were studied. Six hospital admissions were recorded for 6.4% of the patients. The overall mortality rate was 16% (9982 patients). The readmissions rate steadily increased with each new admission, from 48% after the first event to 74.6% after the fifth. The rate of hospital readmission before 30days increased from 18.3% in the second admission to 36.3% in the sixth. The number of chronic diseases increased from 3.1 (SD, 2) in the first hospital admission up to 4.9 (2.8) in the sixth. The Department of Internal Medicine treated a third of all hospital admissions. In the sixth hospitalization, conditions associated with admission in Internal Medicine were CIRS score, age, heart failure, COPD, dementia, diabetes, atrial fibrillation and anemia. CONCLUSIONS Patients with multiple hospital admissions are complex patients whose temporal pattern of readmissions changes with time, such that each hospital admission constitutes a factor facilitating the next.
Collapse
Affiliation(s)
- María Matesanz-Fernández
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Rafael Monte-Secades
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Iria Íñiguez-Vázquez
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Davis Rubal-Bran
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Héctor Guerrero-Sande
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Emilio Casariego-Vales
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| |
Collapse
|
15
|
Rabuñal-Rey R, Monte-Secades R, Gomez-Gigirey A, Pértega-Díaz S, Testa-Fernández A, Pita-Fernández S, Casariego-Vales E. Electrocardiographic abnormalities in centenarians: impact on survival. BMC Geriatr 2012; 12:15. [PMID: 22520618 PMCID: PMC3416736 DOI: 10.1186/1471-2318-12-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 04/20/2012] [Indexed: 11/23/2022] Open
Abstract
Background The centenarian population is gradually increasing, so it is becoming more common to see centenarians in clinical practice. Electrocardiogram abnormalities in the elderly have been reported, but several methodological biases have been detected that limit the validity of their results. The aim of this study is to analyse the ECG abnormalities in a prospective study of the centenarian population and to assess their impact on survival. Method We performed a domiciliary visit, where a medical history, an ECG and blood analysis were obtained. Barthel index (BI), cognitive mini-exam (CME) and Charlson index (ChI) were all determined. Patients were followed up by telephone up until their death. Results A total of 80 centenarians were studied, 26 men and 64 women, mean age 100.8 (SD 1.3). Of these, 81% had been admitted to the hospital at least once in the past, 81.3% were taking drugs (mean 3.3, rank 0–11). ChI was 1.21 (SD 1.19). Men had higher scores both for BI (70 -SD 34.4- vs. 50.4 -SD 36.6-, P = .005) and CME (16.5 -SD 9.1- vs. 9.1 –SD 11.6-, P = .008); 40.3% of the centenarians had anaemia, 67.5% renal failure, 13% hyperglycaemia, 22.1% hypoalbuminaemia and 10.7% dyslipidaemia, without statistically significant differences regarding sex. Only 7% had a normal ECG; 21 (26.3%) had atrial fibrillation (AF), 30 (37.5%) conduction defects and 31 (38.8%) abnormalities suggestive of ischemia, without sex-related differences. A history of heart disease was significantly associated with the presence of AF (P = .002, OR 5.2, CI 95% 1.8 to 15.2) and changes suggestive of ischemia (P = .019, OR 3.2, CI 95% 1.2-8.7). Mean survival was 628 days (SD 578.5), median 481 days. Mortality risk was independently associated with the presence of AF (RR 2.0, P = .011), hyperglycaemia (RR 2.2, P = .032), hypoalbuminaemia (RR 3.5, P < .001) and functional dependence assessed by BI (RR 1.8, P = .024). Conclusion Although ECG abnormalities are common in centenarians, they are not related to sex, functional capacity or cognitive impairment. The only abnormality that has an impact on survival is AF.
Collapse
Affiliation(s)
- Ramón Rabuñal-Rey
- Internal Medicine Department, Lucus Augusti University Hospital (HULA), SERGAS, San Cibrao, s/n, 27003, Lugo, Spain.
| | | | | | | | | | | | | |
Collapse
|
16
|
Piñeiro-Fernández JC, Casariego-Vales E. Hospitalización, multimorbilidad y edad avanzada: ¿realmente actuamos bien? Gal Clin 2000. [DOI: 10.22546/62/2691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|