Frecuencia de reingresos hospitalarios y factores asociados en afiliados a una administradora de servicios de salud en Colombia / Hospital readmission rate and associated factors among health services enrollees in Colombia / Frequência de readmissões e fatores associados em filiados a serviços de saúde na Colômbia

Resumen: Los reingresos hospitalarios son frecuentes y costosos, en Colombia existe poca información. El objetivo fue establecer la frecuencia de reingresos hospitalarios por cualquier causa a 30 días y factores asociados. Se trata de un estudio analítico con cohorte retrospectiva 64.969 hospitalizaciones entre enero de 2008 y enero de 2009 en 47 ciudades colombianas 6.573 reingresos hospitalarios, prevalencia: 10,1% (hombres 10,9%; mujeres 9,5%), 44,7% en > 65 años. Mortalidad mayor en reingresos hospitalarios (5,8% vs. 1,8%). Mayor carga de reingresos hospitalarios en grupo sistema circulatorio. Mayor probabilidad de reingresos hospitalarios en enfermedades hematológicas y neoplasias. Estancia hospitalaria promedio durante el primer ingreso: 7 días en pacientes que reingresaron y 4,5 en quienes no. Costo total mayor para reingresos hospitalarios (USD 21.998.275): 15,8% del costo total de hospitalizaciones. Mayor prevalencia en pacientes remitidos (18,8%) y de consulta externa (13,7%). Los reingresos hospitalarios son frecuentes, se asocian con mayor estancia, mortalidad y costo. Mayor riesgo de reingresos hospitalarios en sexo masculino, > 65 años, pacientes remitidos de otra institución, enfermedades hematológicas y neoplasias.

Abstract: Hospital readmissions are common and expensive, and there is little information on the problem in Colombia. The objective was to determine the frequency of 30-day all-cause hospital readmissions and associated factors. This was a retrospective analytical cohort study of 64,969 hospitalizations from January 2008 to January 2009 in 47 Colombian cities. 6,573 hospital readmissions, prevalence: 10.1% (men 10.9%, women 9.5%), 44.7% > 65 years of age. Hospital readmissions was associated with higher mortality (5.8% vs. 1.8%). There was an increase in the Hospital readmissions rate in patients with diseases of the circulatory system. Hospital readmissions was more likely in hematological diseases and neoplasms. Mean length of stay during the first readmission was 7 days in patients that were readmitted and 4.5 in those without readmission. Greater total cost of hospital readmissions (USA 21,998,275): 15.8% of the total cost of hospitalizations. Higher prevalence rates in referred patients (18.8%) and patients from the outpatient clinic (13.7%). Hospital readmissions is common and is associated with longer length of hospital stay and higher mortality and cost. Increased risk of hospital readmissions in men > 65 years, patients referred from other institutions, and in hematological diseases and neoplasms.

Resumo: Readmissões hospitalares são comuns e caras; na Colômbia há pouca informação. O objetivo foi determinar a frequência de readmissões hospitalares por qualquer causa aos 30 dias e fatores associados. Estudo analítico, coorte retrospectivo 64.969 hospitalizações entre janeiro de 2008 e janeiro de 2009 em 47 cidades colombianas. Seis mil quinhentos e setenta e três readmissões hospitalares, prevalência: 10,1% (homens 10,9%, mulheres 9,5%), 44,7% com > 65 anos. Maior mortalidade em readmissões hospitalares (5,8% vs. 1,8%). Aumento do número de readmissões hospitalares no grupo de sistema circulatório. Maior probabilidade de readmissões hospitalares em doenças hematológicas e neoplasias. Tempo médio de internação, durante a primeira readmissão: 7 dias em pacientes que foram readmitidos e 4,5 naqueles sem readmissão. Maior custo total de readmissões hospitalares (USD 21.998.275): 15,8% do custo total das internações. Maiores prevalências em pacientes encaminhados (18,8%) e pacientes do ambulatório (13,7%). Readmissões hospitalares são comuns, estão associadas com o maior tempo de hospitalização, mortalidade e custo. Aumento do risco de readmissões hospitalares em homens com > 65 anos, pacientes encaminhados de outras instituições, doenças hematológicas e neoplasias.

Case management hospitalario (manejo de casos): una forma alternativade manejar pacientes de alto riesgode estadías hospitalarias prolongadas,de reingreso, o con múltiplesrequerimientos al momento del alta / Hospital case management

Due to demographic changes, rising health expenditures, and the reimbursement mechanisms of insurers in the past 30 years, physicians and nurses have had to changethe way services are delivered. Concepts such as cost effectiveness and patient safetyhave also led to the emergence of case management. Case management, usually ledby nurses, is responsible for early recognition of patients at high risk for prolongedhospitalization, readmission, a high level of consumption of healthcare resources,and mobilizing strategies to discharge patients as soon as possible in a safe mannerwith appropriate medical follow-up. Additionally, the case management teams areresponsible for patient education in a systematic way, for proper codification ofdiagnoses, and for ensuring proper documentation at the moment of discharge. Casemanagement has proven to reduce the length of hospital stays and readmissions. Italso facilitates the care of patients who are overwhelmed by the increasingly complexhospital procedures that they must endure. This is an exhaustive review of the literature about hospital-based case management, its origins, characteristics, types, andhow it has produced a positive impact on patient safety and metrics within hospitals.

Costs and length of hospitalization following kidney transplantation

We assessed the costs of hospital admissions and length of hospital stay in kidney allograft recipients admitted to our center, in order to rank hospitalization causes in terms of costly and prolonged admissions, to bring to light the respective correlates of costly and prolonged admissions, and to investigate the relationship between costs and length of rehospitalizations. Among rehospitalizations, 83.3% of those due to cerebrovascular accident were costly and 51% of those with graft rejection resulted in prolonged hospital stays. Costly admissions had a high regularity in cases of patients older than 60 years, end-stage renal disease due to diabetes mellitus, graft loss, intensive care unit admission, and hospitalizations accompanied by in death. Prolonged stays were more common in those who were admitted to intensive care unit and those who ultimately died. The Costs showed a significant correlation with the length of rehospitalization [r = 0.626, P = .001]. The strong correlation between the length of hospitalization and posttransplant hospitalization costs means that the former should be curtailed by focusing on such correlates of high-cost admissions as high age and diabetes mellitus as the cause of kidney failure

Como reduzir custos e reinternações na insuficiência cardíaca / How to decrease costs and readmissions for hrat failure

A insuficiência cardíaca congestiva é um sério problema para o Sistema de Saúde pelos elevados custos de seu tratamento , boa parte dos quais destinada à intenações hospitalares. Com o envelhecimento da população e a redução da mortalidade por doenças cardiovasculares, a prevalência de Insuficiência caríaca congestiva tem aumentado e essa tendência deve se manter nos próximos anos. Dessa forma, medidas que levam à redução do número de internações hospitalares por insuficiência cardíaca congestiva têm enorme importância. O uso otimizado de medicamentos e dispositivos que comprovadamente modificam a evolução e/ou melhoram o controle de sintomas de insuficiência cardíaca congestiva, a melhora da acurácia do diagnóstico a maior aderência e participação do paciente no tratamento, e modalidades de atendimento alternativas à internação hospitalar são medidas que se mostraram eficientes na diminuição de internações e dos custos por insuficiência cardíaca congestiva. Tais medidas foram divididas em quatro grupos, que serão abordados no artigo: 1) Otimização de terapêutica: drogas e dispositivos, 2) Dosagem dos peptídeos natriuréticos proBNP e BNP, 3) Clínicas de insuficiência cardíaca congestiva. e 4) Atendimento pré-hospitalar em hospital dia.