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Internal medicine and emergency admissions: from a national hospital discharge records (SDO) study to a regional analysis

机译：内科和急诊：从国家医院出院记录（SDO）研究到区域分析

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In Italy, the number of internists has grown by 10% since 1990 reaching 11,435 units, they manage 39,000 beds in 1060 Internal Medicine (IM) wards. The Internists are expected to ensure a cost-effective management of poly-pathological and complex patients. A collaborative study between the Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) and the Consortium for Applied Health Economics Research (C.R.E.A. Sanità) based on data from hospital discharge records has been conducted starting from November 2014. In this article the preliminary results are shown with focus on emergency admissions characteristics to contribute to define the role of hospital IM. Evaluation is performed comparing emergency and planned admissions, IM impact on hospital admissions, availability of community-based healthcare services, diagnosis-related groups (DRGs) weight in IM and regional differences in managing hospital admissions with focus on IM department. In 2013 IM wards discharged 1,073,526 patients (16.18% of the total discharged by hospitals) with a total economic value of 3,426,279.88 € (average DRG 3882.80 €, from 3682.19 to 4083.42). The average length of stay (LOS) in IM was 9.3 days. IM covers 27% of admissions from Emergency Room. Determinants significantly affecting the emergency admissions are old age and comorbidities of the patients that also have a role in increasing LOS. 55% of Italian hospital admissions are emergency admissions. Hospitalization rates in emergency are systematically higher than those in election and the greatest differences are in the regions with inefficiently organized regional network. The role of the hospital IM appears central in the offer of beds to the emergency room by accepting 27% of urgent admissions. The increasing impact of IM on hospital management will put the internists as authoritative stakeholders in health policy.
机译：在意大利，自1990年以来，内科医生的人数增长了10％，达到11,435名，在1060内科（IM）病房中管理着39,000张病床。预计实习医生将确保对多病理和复杂患者进行经济有效的管理。自2014年11月起，医院内科医师协会联合会（FADOI）和应用卫生经济学研究联合会（CREASanità）之间进行了一项基于医院出院记录数据的合作研究。在本文中，初步结果显示的重点是急诊入院特征，有助于定义医院IM的作用。评估的目的是比较急诊和计划住院，即时医疗对医院接诊的影响，基于社区的医疗服务的可用性，即时医疗中与诊断相关的群体（DRG）的权重以及在管理住院病人方面的区域差异，重点是即时医疗部门。 2013年，IM病房共出院1,073,526例患者（占医院出院总数的16.18％），总经济价值为3,426,279.88€（平均DRG 3882.80€，从3682.19至4083.42）。 IM中的平均住院时间（LOS）为9.3天。 IM覆盖了急诊室入院人数的27％。严重影响紧急入院的决定因素是患者的老年和合并症，它们也可增加LOS。意大利55％的住院病人为急诊病人。紧急情况下的住院率有系统地高于选举时的住院率，最大的差异是区域网络组织效率低下的地区。医院IM的作用在接受急诊病床的27％时，在向急诊室提供病床中显得至关重要。 IM对医院管理的影响越来越大，这将使内科医生成为卫生政策中的权威利益相关者。

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