RT Journal Article
SR Electronic
T1 Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study
JF CMAJ Open
FD Canadian Medical Association
SP E842
OP E849
DO 10.9778/cmajo.20170097
VO 5
IS 4
A1 Amol A. Verma
A1 Yishan Guo
A1 Janice L. Kwan
A1 Lauren Lapointe-Shaw
A1 Shail Rawal
A1 Terence Tang
A1 Adina Weinerman
A1 Peter Cram
A1 Irfan A. Dhalla
A1 Stephen W. Hwang
A1 Andreas Laupacis
A1 Muhammad M. Mamdani
A1 Steven Shadowitz
A1 Ross Upshur
A1 Robert J. Reid
A1 Fahad Razak
YR 2017
UL http://www.cmajopen.ca/content/5/4/E842.abstract
AB Background: The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area.Methods: This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period.Results: There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%).Interpretation: Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system.