Amol A Verma1, Yishan Guo1, Janice L Kwan1, Lauren Lapointe-Shaw1, Shail Rawal1, Terence Tang1, Adina Weinerman1, Peter Cram1, Irfan A Dhalla1, Stephen W Hwang1, Andreas Laupacis1, Muhammad M Mamdani1, Steven Shadowitz1, Ross Upshur1, Robert J Reid1, Fahad Razak1. 1. Affiliations: Li Ka Shing Centre for Healthcare Analytics Research and Training (Verma, Mamdani), St. Michael's Hospital; Eliot Phillipson Clinician-Scientist Training Program (Verma), Department of Medicine, University of Toronto; Li Ka Shing Knowledge Institute (Guo, Dhalla, Hwang, Laupacis, Mamdani, Razak), St. Michael's Hospital; Department of Medicine (Kwan), Sinai Health System; Department of Medicine (Kwan, Lapointe-Shaw, Rawal, Razak, Tang, Weinerman), University of Toronto; Division of General Internal Medicine (Rawal), University Health Network; Institute for Better Health (Tang, Reid), Trillium Health Partners; Sunnybrook Health Sciences Centre (Weinerman); University Health Network, Sinai Health System (Cram), University of Toronto; Health Quality Ontario (Dhalla); Sunnybrook Health Sciences Centre (Shadowitz), University of Toronto; Bridgepoint Health (Upshur), University of Toronto, Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass.
Abstract
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. Copyright 2017, Joule Inc. or its licensors.
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. Copyright 2017, Joule Inc. or its licensors.
Authors: Justin E Bekelman; Scott D Halpern; Carl Rudolf Blankart; Julie P Bynum; Joachim Cohen; Robert Fowler; Stein Kaasa; Lukas Kwietniewski; Hans Olav Melberg; Bregje Onwuteaka-Philipsen; Mariska Oosterveld-Vlug; Andrew Pring; Jonas Schreyögg; Connie M Ulrich; Julia Verne; Hannah Wunsch; Ezekiel J Emanuel Journal: JAMA Date: 2016-01-19 Impact factor: 56.272
Authors: Kristian B Filion; Laurent Azoulay; Robert W Platt; Matthew Dahl; Colin R Dormuth; Kristin K Clemens; Nianping Hu; J Michael Paterson; Laura Targownik; Tanvir C Turin; Jacob A Udell; Pierre Ernst Journal: N Engl J Med Date: 2016-03-24 Impact factor: 91.245
Authors: Shail Rawal; Janice L Kwan; Fahad Razak; Allan S Detsky; Yishan Guo; Lauren Lapointe-Shaw; Terence Tang; Adina Weinerman; Andreas Laupacis; S V Subramanian; Amol A Verma Journal: JAMA Intern Med Date: 2019-01-01 Impact factor: 21.873
Authors: Amol A Verma; Sachin V Pasricha; Hae Young Jung; Vladyslav Kushnir; Denise Y F Mak; Radha Koppula; Yishan Guo; Janice L Kwan; Lauren Lapointe-Shaw; Shail Rawal; Terence Tang; Adina Weinerman; Fahad Razak Journal: J Am Med Inform Assoc Date: 2021-03-01 Impact factor: 4.497
Authors: Amol A Verma; Tejasvi Hora; Hae Young Jung; Michael Fralick; Sarah L Malecki; Lauren Lapointe-Shaw; Adina Weinerman; Terence Tang; Janice L Kwan; Jessica J Liu; Shail Rawal; Timothy C Y Chan; Angela M Cheung; Laura C Rosella; Marzyeh Ghassemi; Margaret Herridge; Muhammad Mamdani; Fahad Razak Journal: CMAJ Date: 2021-06-07 Impact factor: 8.262